NPIMap

Organization Active NPI

Kaiser Foundation Health Plan of Georgia, Inc.

Doing business as Kaiser Permanente West Marietta

  • Managed Care Organization Pharmacy
  • Marietta, GA
National Provider Identifier
1063733210
Registry record updated Jul 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Managed Care Organization PharmacyTaxonomy code 3336M0003X
License
PHRE009685 Issued in GA
Legal business name
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Doing business as
Kaiser Permanente West Marietta
Practice address
2505 Dallas Hwy SW
Marietta, GA 30064-2659
Phone
(770) 792-2010
Fax
(770) 792-2003
NPI assigned
Jun 22, 2010
Last updated
Jul 10, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Diane Sanders
Title
Pharmacy Compliance Manager
Phone
(404) 949-5336

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Managed Care Organization Pharmacy 3336M0003X PHRE009685 GA Primary

Addresses

Primary practice location

2505 Dallas Hwy SW
Marietta, GA 30064-2659

Mailing address

3495 Piedmont Rd NE
Atlanta, GA 30305-1717
Phone (404) 364-4824

Other names 1

  • Kaiser Permanente West Marietta Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Foundation HLTH67 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Locations

2505 Dallas Hwy SW
Marietta, GA 30064
Phone (678) 956-6230

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436486400000",
    "number": "1063733210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 PIEDMONT RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303051717",
            "telephone_number": "404-364-4824",
            "fax_number": "404-949-5242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 DALLAS HWY SW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300642659",
            "telephone_number": "770-792-2010",
            "fax_number": "770-792-2003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-22",
        "last_updated": "2015-07-10",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "PHARMACY COMPLIANCE MANAGER",
        "authorized_official_telephone_number": "404-949-5336"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Managed Care Organization Pharmacy",
            "state": "GA",
            "license": "PHRE009685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kaiser Permanente West Marietta",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.