Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
Other names
Kaiser Permanente Fayette
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE SANDERS (PHARMACY COMPLIANCE MANAGER)
(770) 712-5654
Entity
Organization
Contact information
Practice address
101 BANKS STA, FAYETTEVILLE, GA 30214-7507
(678) 610-3701
(678) 610-3703
Mailing address
101 BANKS STA, FAYETTEVILLE, GA 30214-7507
(678) 610-3701
(678) 610-3703
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
Primary
PHRE009731
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2127407
PK
—
Enumeration date
02/08/2011
Last updated
08/04/2021
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