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NPI Code Detail

MEDICARE: KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.

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
13336M0003XManaged Care Organization PharmacyPHRE007149GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11138305OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1932141710
Entity Type Code : Organization
Provider Name (Legal Business Name) : KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Provider Business Mailing Address
First Line : 1175 CASCADE PKWY SW
Second Line :
City : ATLANTA
State : GA
Zip : 30311-3090
Country : US
Telephone Number : 404-505-4071
Fax Number : 404-505-4182
Provider Business Practice Location Address
First Line : 1175 CASCADE PKWY SW
Second Line :
City : ATLANTA
State : GA
Zip : 30311-3090
Country : US
Telephone Number : 404-505-4071
Fax Number : 404-505-4182
Authorized Official
Title or Position : PHCY COMPLIANCE MGR
Name : MS. DIANE SANDERS
Credential :
Telephone Number : 770-712-5654
Provider Enumeration Date : 06/13/2006
Last Update Date : 08/04/2021

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1447354808 — ALGERNON O STEELE MD
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1144303280 — ROBYN ALLEN PETAGREW DO
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