Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
Other names
Kaiser Permanente Southwood Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE SANDERS (PHARMACY COMPLIANCE MANAGER)
(770) 712-5654
Entity
Organization
Contact information
Practice address
2400 MOUNT ZION PKWY, JONESBORO, GA 30236-2500
(770) 603-4242
(770) 603-4243
Mailing address
2400 MOUNT ZION PKWY, JONESBORO, GA 30236-2500
(770) 603-4242
(770) 603-4243
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
PHCL000025
GA
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2144375
PK
—
Enumeration date
02/25/2014
Last updated
08/04/2021
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