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General NPI Number Information
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NPI Number | 1750266219
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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 | 08/06/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 200 CRESCENT CENTER PKWY
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City | TUCKER
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State | GA
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Zip | 30084-7047
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Country | US
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Telephone | 770-621-6834
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Fax |
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Provider Business Mailing Address
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Address Line | 200 CRESCENT CENTER PKWY
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City | TUCKER
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State | GA
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Zip | 30084-7047
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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 | VP & CHIEF FINANCIAL OFFICER
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Name | NOEL BABER
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Credential |
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Telephone | 419-351-7513
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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 |
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License Number State |
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