Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
Other names
Kaiser Permanente Lawrenceville
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE SANDERS (PHARMACY COMPLIANCE MANAGER)
(770) 712-5654
Entity
Organization
Contact information
Practice address
455 PHILIP BLVD STE 130, LAWRENCEVILLE, GA 30046-8767
(678) 985-5040
(678) 985-5003
Mailing address
455 PHILIP BLVD STE 130, LAWRENCEVILLE, GA 30046-8767
(678) 985-5040
(678) 985-5003
Taxonomy
Speciality
Code
Description
License number
State
3336M0003X
Managed Care Organization Pharmacy
Primary
PHRE009655
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1159703
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/19/2010
Last updated
08/04/2021
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