Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC
Active
Other names
Kaiser Permanente Athens
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE SANDERS (PHARMACY COMPLIANCE MANAGER)
(770) 712-5654
Entity
Organization
Contact information
Practice address
2142 W BROAD ST BLDG 200, ATHENS, GA 30606-3509
(706) 583-5001
(706) 583-5003
Mailing address
2142 W BROAD ST BLDG 200, ATHENS, GA 30606-3509
(706) 583-5001
(706) 583-5003
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
Primary
PHRE009793
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1161900
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/28/2011
Last updated
08/04/2021
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