Organization
KAISER PERMANENTE INTERNAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE SANDERS HARVEY (PHCY COMPLIANCE MGR GA)
(404) 949-5336
Entity
Organization
Contact information
Practice address
200 CRES CTR PKWY, TUCKER, GA 30084-7047
(770) 496-3623
(770) 496-3528
Mailing address
200 CRES CTR PKWY, TUCKER, GA 30084-7047
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
Primary
07798
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1141023
OTHER ID NUMBER
—
Enumeration date
06/22/2006
Last updated
07/19/2007
Update your record
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