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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1225979289
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
Second Line	:
City	:	SHARPSBURG
State	:	GA
Zip	:	30277-3681
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 FISCHER CROSSINGS DR
Second Line	:
City	:	SHARPSBURG
State	:	GA
Zip	:	30277-3681
Country	:	US
Telephone Number	:	404-365-0966
Fax Number	:

Authorized Official
Title or Position	:	VP & CHIEF FINANCIAL OFFICER
Name	:	NOEL BABER
Credential	:
Telephone Number	:	404-365-0966

Provider Enumeration Date	:	04/03/2026
Last Update Date	:	04/06/2026

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