Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
Other names
KAISER PERMANENTE SOUTHWOOD INFUSION PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE SANDERS (PHARMACY COMPLIANCE MANAGER)
(770) 712-5654
Entity
Organization
Contact information
Practice address
2400 MOUNT ZION PKWY, JONESBORO, GA 30236-2500
(770) 603-3847
(770) 603-3561
Mailing address
2400 MOUNT ZION PKWY, JONESBORO, GA 30236-2500
(770) 603-3847
(770) 603-3561
Taxonomy
Speciality
Code
Description
License number
State
3336M0003X
Managed Care Organization Pharmacy
Primary
PHCL000019
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2122375
PK
—
Enumeration date
11/04/2009
Last updated
08/04/2021
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