| Organization Name: | KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC. |
| NPI Number: | 1053612119 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANE SANDERS (PHARMACY COMPLIANCE MANAGER) |
| Mailing Address: | 205 Newnan Crossing Byp Newnan |
| State: | GA US |
| Postal Code: | 302651063 |
| Phone Number: | 7703044410 |
| Fax Number: | 7703044402 |
| NPI Enumeration Date: | 11/05/2010 |
| NPI Last Update Date: | 12/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336M0003X |
| License Number: | PHRE009710 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Managed Care Organization Pharmacy |
| Taxonomy Definition: | A pharmacy owned by a managed care organization (MCO) used by pharmacists for the compounding and dispensing of medicinal preparations to that MCO |