Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
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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