Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
Other names
KAISER PERMANENTE STONECREST
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE SANDERS (PHARMACY COMPLIANCE MANAGER)
(770) 712-5654
Entity
Organization
Contact information
Practice address
8011 MALL PKWY, LITHONIA, GA 30038-2543
(678) 323-7580
(404) 949-5242
Mailing address
8011 MALL PKWY, LITHONIA, GA 30038-2543
(678) 323-7580
(404) 949-5242
Taxonomy
Speciality
Code
Description
License number
State
3336M0003X
Managed Care Organization Pharmacy
Primary
PHRE009408
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1156531
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/13/2007
Last updated
08/04/2021
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