Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
Other names
Kaiser Permanente Conyers
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE SANDERS (PHARMACY COMPLIANCE MANAGER)
(770) 712-5654
Entity
Organization
Contact information
Practice address
1478 DOGWOOD DR SE, CONYERS, GA 30013-5088
(678) 413-4321
(678) 413-4323
Mailing address
1478 DOGWOOD DR SE, CONYERS, GA 30013-5088
(678) 413-4321
(678) 413-4323
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PHRE009716
GA
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1160756
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/21/2010
Last updated
08/04/2021
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