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NPI Code Detail

MEDICARE: KAISER FOUNDATION HEALTH PLAN OF GEORGIA

MEDICARE: KAISER FOUNDATION HEALTH PLAN OF GEORGIA
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
1291U00000XClinical Medical Laboratory11D2066504GA

General Provider Information

NPI Number : 1164850814
Entity Type Code : Organization
Provider Name (Legal Business Name) : KAISER FOUNDATION HEALTH PLAN OF GEORGIA
Provider Business Mailing Address
First Line : 3495 PIEDMONT RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30305-1717
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1100 LAKE HEARN DR
Second Line : SUITE 500
City : SANDY SPRINGS
State : GA
Zip : 30342-1523
Country : US
Telephone Number : 404-845-4520
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF LABORATORY SERVICES
Name : KATHERINE FARMER
Credential :
Telephone Number : 404-309-9314
Provider Enumeration Date : 10/16/2013
Last Update Date : 07/15/2021

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Directions to “KAISER FOUNDATION HEALTH PLAN OF GEORGIA ” Practice Location

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