Organization · Type 2 NPI

Kaiser Foundation Health Plan of Georgia, Inc.

Managed Care Organization Pharmacy · Atlanta, GA

NPI number 1093757809 Active

Practice location

20 Glenlake Pkwy NE
Atlanta, GA 30328-3473

Fax (770) 677-7306

Specialties and licenses

Taxonomy	Code	License
Managed Care Organization Pharmacy Primary	3336M0003X	PHRE007915 (GA)

Managed Care Organization Pharmacy: 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.

9 other providers at this address

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NPI record

NPI: 1093757809
Entity type: Organization (Type 2)
Issued: Jun 13, 2006
Last updated: Aug 4, 2021
Status: Active

Other names

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Kaiser Permanente Glenlake · doing business as
Kaiser Permanente Glenlake · doing business as

Authorized official

Ms. Diane Sanders
Phcy Compliance MGR
(770) 712-5654

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1093757809

Kaiser Foundation Health Plan of Georgia, Inc.'s National Provider Identifier is 1093757809, issued on Jun 13, 2006. The primary taxonomy on file is Managed Care Organization Pharmacy (3336M0003X), and the practice location is in Atlanta, GA. The record was last updated on Aug 4, 2021.