Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
Other names
Kaiser Permanente Snellville
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE SANDERS (PHARMACY COMPLIANCE MANAGER)
(404) 949-5336
Entity
Organization
Contact information
Practice address
2240 FOUNTAIN DR, SNELLVILLE, GA 30078-2919
(770) 978-5399
(770) 978-5397
Mailing address
2240 FOUNTAIN DR, SNELLVILLE, GA 30078-2919
(770) 978-5399
(770) 978-5397
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
Primary
PHRE009686
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1159931
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/14/2010
Last updated
08/04/2021
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