# KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
- **Other names:** Southwood Home Infusion Retail Pharmacy
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1477272854
- **Legal business name:** KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
- **Authorized official:** MS. DIANE SANDERS (PHARMACY COMPLIANCE MANAGER)
- **Authorized official phone:** (770) 712-5654

## Contact information

- **Practice address:** 2400 MOUNT ZION PKWY RM 101A503, JONESBORO, GA 30236-2500
- **Practice address phone:** (770) 603-3953
- **Practice address fax:** (770) 603-3958
- **Mailing address:** 2400 MOUNT ZION PKWY RM 101A503, JONESBORO, GA 30236-2500
- **Mailing address phone:** (770) 603-3953
- **Mailing address fax:** (770) 603-3958

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 08/26/2022
- **Last updated:** 08/26/2022