KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. NPI 1093757809

NPI Information

KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC. is a managed care organization pharmacy pharmacy in Atlanta, GA. The provider is a pharmacy owned by a managed care organization (MCO) used by pharmacists for the compounding and dispensing of medicinal preparations to that MCO's covered members only. KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC. NPI is 1093757809. The provider is registered as an organization entity type.
The provider Is Doing Business As Kaiser Permanente Glenlake.

The provider's business location address is:

20 GLENLAKE PKWY NE
ATLANTA, GA
ZIP 30328-473
Phone: (770) 677-6000
Fax: (770) 677-7306

The provider's authorized official is Diane Sanders .
The authorized official title is Phcy Compliance Mgr and has the following contact phone number (770) 712-5654.

The CLIA number assigned to this NPI record is 11D0259776 - health main. organization with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 6/13/2006 and was last updated on 8/4/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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