Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
Other names
Kaiser Permanente Decatur Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE SANDERS (PHARMACY COMPLIANCE MANAGER)
(404) 949-5336
Entity
Organization
Contact information
Practice address
201 W PONCE DE LEON AVE, DECATUR, GA 30030-3217
(404) 687-7680
(404) 687-7730
Mailing address
201 W PONCE DE LEON AVE, DECATUR, GA 30030-3217
(404) 687-7680
(404) 687-7730
Taxonomy
Speciality
Code
Description
License number
State
3336M0003X
Managed Care Organization Pharmacy
Primary
PHRE009629
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1159335
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/02/2009
Last updated
08/04/2021
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