KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. NPI 1396781779

NPI Information

  • NPI: 1396781779
  • Provider Name: KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
  • Classification: Pharmacy - 3336M0003X
  • Specialization: Managed Care Organization Pharmacy
  • Entity Type: Organization
  • Doing Business As: KAISER PERMANENTE GWINNETT
  • CLIA Number: 11D0933683
  • Address: 3650 STEVE REYNOLDS BLVD
    DULUTH, GA
    ZIP 30096
  • Phone: (770) 931-6134

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NPI Details

KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC. is a managed care organization pharmacy pharmacy in Duluth, 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 1396781779. The provider is registered as an organization entity type.
The provider Is Doing Business As Kaiser Permanente Gwinnett.

The provider's business location address is:

3650 STEVE REYNOLDS BLVD
DULUTH, GA
ZIP 30096-506
Phone: (770) 931-6134
Fax: (770) 931-6403

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 11D0933683 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 6/22/2006 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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacyNo
23336M0003XPharmacyManaged Care Organization PharmacyPHRE07776GEORGIAYes

Other Identifiers

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

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11140956OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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