NPIMap

Kaiser Foundation Health Plan of Georgia, Inc.

Organization Active NPI Clinic Pharmacy · Jonesboro, GA

NPI 1861817017 · NPPES record last updated Aug 4, 2021

Key facts

NPI
1861817017
Entity type
Organization (NPI type 2)
Primary specialty
Clinic Pharmacy 3336C0002X
License
PHCL000025 (GA)
Legal business name
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Practice address
2400 Mount Zion Pkwy
Jonesboro, GA 30236-2500
Phone
(770) 603-4242
Fax
(770) 603-4243
NPI assigned
Feb 25, 2014
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 20

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Kaiser Foundation Health (67 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Clinic Pharmacy 3336C0002X PHCL000025 GA Yes
Managed Care Organization Pharmacy 3336M0003X

Addresses

Primary practice location

2400 Mount Zion Pkwy
Jonesboro, GA 30236-2500

Mailing address

2400 Mount Zion Pkwy
Jonesboro, GA 30236-2500
Phone (770) 603-4242

Other identifiers

IdentifierTypeStateIssuer
2144375OtherPK

Other names

  • Kaiser Permanente Southwood Clinic Pharmacy Doing business as

Electronic endpoints

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 4, 2021.

{
    "created_epoch": "1393286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628035200000",
    "number": "1861817017",
    "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": "770-603-4242",
            "fax_number": "770-603-4243"
        },
        {
            "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": "770-603-4242",
            "fax_number": "770-603-4243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-25",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "GA",
            "license": "PHCL000025",
            "primary": true
        },
        {
            "code": "3336M0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Managed Care Organization Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2144375",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "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 Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kaiser Permanente Southwood Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jonesboro, GA

All providers in Jonesboro, GA · Clinic Pharmacy in Georgia

Sources for this page

Verify at the official NPI Registry.