Organization · Type 2 NPI

Kaiser Foundation Health Plan of Georgia, Inc.

Managed Care Organization Pharmacy · Fayetteville, GA

NPI number 1831495803 Active

Practice location

101 Banks Sta
Fayetteville, GA 30214-7507

Fax (678) 610-3703

Specialties and licenses

Taxonomy	Code	License
Pharmacy	333600000X	None listed
Managed Care Organization Pharmacy Primary	3336M0003X	PHRE009731 (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.

5 other providers at this address

NPI record

NPI: 1831495803
Entity type: Organization (Type 2)
Issued: Feb 8, 2011
Last updated: Aug 4, 2021
Status: Active

Other names

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Kaiser Permanente Fayette · doing business as
Kaiser Permanente Fayette · 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 1831495803

Kaiser Foundation Health Plan of Georgia, Inc.'s National Provider Identifier is 1831495803, issued on Feb 8, 2011. The primary taxonomy on file is Managed Care Organization Pharmacy (3336M0003X), and the practice location is in Fayetteville, GA. The record was last updated on Aug 4, 2021.