Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
Other names
KAISER PERMANENTE
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE SANDERS RPH (PHRM COMPL MANG)
(404) 949-5242
Entity
Organization
Contact information
Practice address
3640 TRAMORE POINTE PKWY, AUSTELL, GA 30106-6825
(770) 439-4703
(770) 439-4743
Mailing address
3640 TRAMORE POINTE PKWY, AUSTELL, GA 30106-6825
(770) 439-4703
(770) 439-4743
Taxonomy
Speciality
Code
Description
License number
State
3336M0003X
Managed Care Organization Pharmacy
Primary
PHRE009118
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2016476
PK
—
Enumeration date
02/15/2007
Last updated
08/04/2021
Update your record
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