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	:	1750266219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC

Provider Business Mailing Address
First Line	:	200 CRESCENT CENTER PKWY
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-7047
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 CRESCENT CENTER PKWY
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-7047
Country	:	US
Telephone Number	:	770-621-6834
Fax Number	:

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

Provider Enumeration Date	:	08/06/2025
Last Update Date	:	04/06/2026

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