Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
Other names
Kaiser Permanente West Marietta
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE SANDERS (PHARMACY COMPLIANCE MANAGER)
(404) 949-5336
Entity
Organization
Contact information
Practice address
2505 DALLAS HWY SW, MARIETTA, GA 30064-2659
(770) 792-2010
(770) 792-2003
Mailing address
3495 PIEDMONT RD NE, ATLANTA, GA 30305-1717
(404) 364-4824
(404) 949-5242
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
Primary
PHRE009685
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2125368
PK
—
Enumeration date
06/22/2010
Last updated
07/10/2015
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