Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
Other names
KAISER PERMANENTE CRESCENT CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE SANDERS-HARVEY (PHCY COMPLIANCE MGR)
(404) 949-5336
Entity
Organization
Contact information
Practice address
200 CRESCENT CENTER PKWY, TUCKER, GA 30084-7047
(770) 496-3523
(770) 496-3713
Mailing address
200 CRESCENT CENTER PKWY, TUCKER, GA 30084-7047
(770) 496-3523
(770) 496-3713
Taxonomy
Speciality
Code
Description
License number
State
3336M0003X
Managed Care Organization Pharmacy
Primary
PHRE007007
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1136111
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/20/2006
Last updated
08/04/2021
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