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General NPI Number Information
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NPI Number | 1609917103
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Entity Type | Organization
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Legal Business Name | KAISER FOUNDATION HEALTH PLAN OF GA
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | KP GLENHKE MEDICAL CENTER 20 GLENLAKE PKWY
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City | ATLANTA
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State | GA
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Zip | 30328
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Country | US
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Telephone | 770-677-6043
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Fax |
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Provider Business Mailing Address
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Address Line | 3495 PIEDMONT ROAD NE NINE PIEDMONT CENTER
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City | ATLANTA
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State | GA
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Zip | 30305
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Country | US
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Telephone | 404-364-7000
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | F BOONE
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Credential |
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Telephone | 404-364-7293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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