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General NPI Number Information
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NPI Number | 1467104182
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Entity Type | Organization
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Legal Business Name | KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 750 TOWNPARK LN NW RM 203F310
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City | KENNESAW
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State | GA
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Zip | 30144-5824
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Country | US
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Telephone | 770-514-5487
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Fax | 770-514-5433
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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 | 770-712-5654
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Fax | 404-949-5242
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Authorized Official
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Title or Position | PHARMACY COMPLIANCE MANAGER
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Name | MS. DIANE SANDERS
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Credential |
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Telephone | 770-712-5654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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