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General NPI Number Information
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NPI Number | 1205130374
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Entity Type | Organization
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Legal Business Name | KAISER PERMANENTE
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 1478 DOGWOOD DR SE SUITE C
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City | CONYERS
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State | GA
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Zip | 30013-5088
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Country | US
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Telephone | 678-413-4320
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Fax | 678-413-4322
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Provider Business Mailing Address
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Address Line | 3495 PIEDMONT RD NE
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City | ATLANTA
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State | GA
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Zip | 30305-1717
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF LABORATORY SERVICES
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Name | KATHERINE FARMER
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Credential |
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Telephone | 404-309-9314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 11D2016612
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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