NPIMap

Organization Active NPI

Coliseum Park Cancer Treatment Center

  • Specialist
  • Macon, GA
National Provider Identifier
1619921020
Registry record updated Aug 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
COLISEUM PARK CANCER TREATMENT CENTER
Practice address
308 Coliseum Dr
Suite 100
Macon, GA 31217-3865
Phone
(478) 742-2278
Fax
(478) 742-2673
NPI assigned
May 20, 2006
Last updated
Aug 28, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dale McCord, MD
Title
Ceo
Phone
(770) 350-0126

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

308 Coliseum Dr
Suite 100
Macon, GA 31217-3865

Mailing address

3330 Preston Ridge Rd
Suite 300
Alpharetta, GA 30005-4508
Phone (770) 350-0126

National Provider Directory

National Provider Directory
Tax ID family
Aoa Gwinnett Operating Company2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

308 Coliseum Dr
Ste 100
Macon, GA 31217
Phone (478) 742-2278

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409184000000",
    "number": "1619921020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3330 PRESTON RIDGE RD",
            "address_2": "SUITE 300",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300054508",
            "telephone_number": "770-350-0126",
            "fax_number": "770-350-6637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 COLISEUM DR",
            "address_2": "SUITE 100",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312173865",
            "telephone_number": "478-742-2278",
            "fax_number": "478-742-2673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLISEUM PARK CANCER TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2014-08-28",
        "status": "A",
        "authorized_official_last_name": "MCCORD",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-350-0126",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.