MEDICARE: KAISER PERMANENTE

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	302R00000X	Health Maintenance Organization	RPH026665	GA

General Provider Information

NPI Number	:	1528401080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAISER PERMANENTE

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	:	3495 PIEDMONT RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-1717
Country	:	US
Telephone Number	:	404-949-5375
Fax Number	:

Authorized Official
Title or Position	:	PGY-1 MANAGED CARE PHARMACY RESIDEN
Name	:	NEELAM PATEL
Credential	:
Telephone Number	:	404-949-5375

Provider Enumeration Date	:	04/15/2013
Last Update Date	:	04/15/2013

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Directions to “KAISER PERMANENTE ” Practice Location

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