Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
Other names
KAISER PERMANENTE HENRY
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE SANDERS (PHCY COMPLIANCE MGR)
(770) 712-5654
Entity
Organization
Contact information
Practice address
1125 TOWN CENTER VILLAGE DR, MCDONOUGH, GA 30253-5970
(678) 583-6560
(678) 583-6563
Mailing address
1125 TOWN CENTER VILLAGE DR, MCDONOUGH, GA 30253-5970
(678) 583-6560
(678) 583-6563
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
Primary
PHRE008647
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1150250
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/13/2006
Last updated
08/04/2021
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