MEDICARE: KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336M0003X	Managed Care Organization Pharmacy

General Provider Information

NPI Number	:	1053266957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.

Provider Business Mailing Address
First Line	:	100 FISCHER CROSSINGS DR STE 115
Second Line	:
City	:	SHARPSBURG
State	:	GA
Zip	:	30277-3681
Country	:	US
Telephone Number	:	404-745-5300
Fax Number	:	404-745-5350

Provider Business Practice Location Address
First Line	:	100 FISCHER CROSSINGS DR STE 115
Second Line	:
City	:	SHARPSBURG
State	:	GA
Zip	:	30277-3681
Country	:	US
Telephone Number	:	770-220-3787
Fax Number	:	770-220-3885

Authorized Official
Title or Position	:	PHARMACY COMPLIANCE MANAGER
Name	:	DIANE SANDERS
Credential	:
Telephone Number	:	770-712-5654

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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