Organization · Type 2 NPI

Kaiser Foundation Health Plan of Georgia, Inc.

Pharmacy · Conyers, GA

NPI number 1174826754 Active

Practice location

1478 Dogwood Dr SE
Conyers, GA 30013-5088

Fax (678) 413-4323

Specialties and licenses

Taxonomy	Code	License
Pharmacy Primary	333600000X	PHRE009716 (GA)
Managed Care Organization Pharmacy	3336M0003X	None listed

Pharmacy: A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is lo…

2 other providers at this address

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NPI record

NPI: 1174826754
Entity type: Organization (Type 2)
Issued: Dec 21, 2010
Last updated: Aug 4, 2021
Status: Active

Other names

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Kaiser Permanente Conyers · doing business as
Kaiser Permanente Conyers · doing business as

Authorized official

Ms. Diane Sanders
Pharmacy Compliance Manager
(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 1174826754

Kaiser Foundation Health Plan of Georgia, Inc.'s National Provider Identifier is 1174826754, issued on Dec 21, 2010. The primary taxonomy on file is Pharmacy (333600000X), and the practice location is in Conyers, GA. The record was last updated on Aug 4, 2021.