Healthcare Provider Details

I. General information

NPI: 1528401080
Provider Name (Legal Business Name): KAISER PERMANENTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 PIEDMONT RD NE
ATLANTA GA
30305-1717
US

IV. Provider business mailing address

3495 PIEDMONT RD NE
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 404-949-5375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberRPH026665
License Number StateGA

VIII. Authorized Official

Name: NEELAM PATEL
Title or Position: PGY-1 MANAGED CARE PHARMACY RESIDEN
Credential:
Phone: 404-949-5375