NPIMap

Organization Active NPI

Kaiser Foundation Health Plan of Georgia, Inc.

Doing business as Kaiser Permanente Southwood Infusion Pharmacy

  • Managed Care Organization Pharmacy
  • Jonesboro, GA
National Provider Identifier
1245567783
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Managed Care Organization PharmacyTaxonomy code 3336M0003X
License
PHCL000019 Issued in GA
Legal business name
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Doing business as
Kaiser Permanente Southwood Infusion Pharmacy
Practice address
2400 Mount Zion Pkwy
Jonesboro, GA 30236-2500
Phone
(770) 603-3847
Fax
(770) 603-3561
NPI assigned
Nov 4, 2009
Last updated
Aug 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Authorized official

Name
Ms. Diane SandersNPI 1811848682
Title
Pharmacy Compliance Manager
Phone
(770) 712-5654

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Managed Care Organization Pharmacy 3336M0003X PHCL000019 GA Primary

Addresses

Primary practice location

2400 Mount Zion Pkwy
Jonesboro, GA 30236-2500

Mailing address

2400 Mount Zion Pkwy
Jonesboro, GA 30236-2500
Phone (770) 603-3847

Other identifiers 1

IdentifierTypeStateIssuer
2122375OtherPK

Other names 1

  • KAISER PERMANENTE SOUTHWOOD INFUSION PHARMACY Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

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 24

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

View all 24

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1257292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628035200000",
    "number": "1245567783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 MOUNT ZION PKWY",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302362500",
            "telephone_number": "770-603-3847",
            "fax_number": "770-603-3561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 MOUNT ZION PKWY",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302362500",
            "telephone_number": "770-603-3847",
            "fax_number": "770-603-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-04",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "PHARMACY COMPLIANCE MANAGER",
        "authorized_official_telephone_number": "770-712-5654",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3336M0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Managed Care Organization Pharmacy",
            "state": "GA",
            "license": "PHCL000019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2122375",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2400 Mount Zion Pkwy",
            "city": "Jonesboro",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302362500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "KAISER PERMANENTE SOUTHWOOD INFUSION PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KAISER PERMANENTE SOUTHWOOD INFUSION PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jonesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; 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.