KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.


Address: 3650 Steve Reynolds Blvd, Duluth, GA 30096-4506
Phone: 7709316134

KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC. (NPI# 1396781779) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1396781779
Entity Type Organization
Organization Name KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Other Organization Name KAISER PERMANENTE GWINNETT
Practice Address 3650 Steve Reynolds Blvd
Duluth
GA 30096-4506
Practice Telephone 7709316134
Practice Fax Number 7709316403
Mailing Telephone 7709316134
Mailing Fax Number 7709316403
Enumeration Date 2006-06-22
Last Update Date 2009-11-09
Authorized Official Name DIANE SANDERS (PHCY COMPLIANCE MGR)
Authorized Official Telephone 4049495336
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 333600000X Pharmacy Suppliers
Y 3336M0003X Pharmacy
Specialization: Managed Care Organization Pharmacy
PHRE07776 GA Suppliers

Other Provider Identifier

State Issuer Identifier Type Code
NCPDP PROVIDER IDENTIFICATION NUMBER 1140956 01

Other Provider/Organization Names

Other Name Type Code
KAISER PERMANENTE GWINNETT Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1811321763 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 1100 Lake Hearn Dr Ste 500, Atlanta, GA 30342-1548 2013-08-28
1598061608 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 225 Peachtree St Ne Ste C-08, Atlanta, GA 30303-1701 2011-02-07
1174826754 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 1478 Dogwood Dr Se, Conyers, GA 30013-5088 2010-12-21
1053612119 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 205 Newnan Crossing Byp, Newnan, GA 30265-1063 2010-11-05
1063733210 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 2505 Dallas Hwy Sw, Marietta, GA 30064-2659 2010-06-22
1538480553 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 2240 Fountain Dr, Snellville, GA 30078-2919 2010-06-14
1881910552 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 684 Sixes Rd Ste 275, Holly Springs, GA 30115-8721 2010-04-20
1144546920 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 455 Philip Blvd Ste 130, Lawrenceville, GA 30046-8767 2010-04-19
1699003681 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 201 W Ponce De Leon Ave, Decatur, GA 30030-3217 2009-12-02
1447487574 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 1400 Northside Forsyth Dr Ste 350, Cumming, GA 30041-6018 2009-06-16

Office Location

Street Address 3650 STEVE REYNOLDS BLVD
City DULUTH
State GA
Zip Code 30096-4506

Providers in the same location

NPI Name Taxonomy Address Enumeration
1831194893 Barbara Joan Kell Nurse Practitioner 3650 Steve Reynolds Blvd, Duluth, GA 30096-4506 2005-06-16
1750906715 Grace Elizabeth Mason Nurse Practitioner 3650 Steve Reynolds Blvd, Duluth, GA 30096-4506 2020-06-15
1881181584 Cynthia Denise Humenic Nurse Practitioner 3650 Steve Reynolds Blvd, Duluth, GA 30096-4506 2018-04-18
1194230540 Jenna Dannenbaum Nurse Practitioner 3650 Steve Reynolds Blvd, Duluth, GA 30096-4506 2017-12-07
1568994135 Yolanda Gray-rozier Registered Nurse 3650 Steve Reynolds Blvd, Duluth, GA 30096-4506 2017-04-01
1306394655 Carlie Lynne Adams Dietitian, Registered 3650 Steve Reynolds Blvd, Duluth, GA 30096-4506 2016-09-15
1114379757 Miriam Abouelnasr Gomes Physician Assistant 3650 Steve Reynolds Blvd, Duluth, GA 30096-4506 2016-07-07
1699158584 Ann Whitaker Dietitian, Registered 3650 Steve Reynolds Blvd, Duluth, GA 30096-4506 2015-07-09
1548643968 Paula Gilman Dietitian, Registered 3650 Steve Reynolds Blvd, Duluth, GA 30096-4506 2015-07-02
1750763173 Emily Kim Internal Medicine 3650 Steve Reynolds Blvd, Duluth, GA 30096-4506 2015-06-22
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1922615897 Georgia Eye Optical, LLC Ophthalmology 3800 Pleasant Hill Rd Ste 3, Duluth, GA 30096 2020-09-25
1568090868 Positive Behavior Services, Inc Behavior Technician 3765 Crestwood Pkwy Nw, Duluth, GA 30096 2020-03-31
1861031940 Elizabeth Ashley Edouard Counselor 3464 Duluth Hwy 120, Duluth, GA 30096 2020-01-06
1245701044 Kathryn Irene Vaughn Social Worker 3968 Mainsail Court, Duluth, GA 30096 2018-12-06
1083184626 Aica Orthopedics, P.C. Orthopaedic Surgery 3775 Venture Drive Bldg F, Duluth, GA 30096 2018-11-27
1245709799 Positive Impact Health Centers, Inc. Pharmacy 3350 Breckinridge Blvd, Suite 200a, Duluth, GA 30096 2018-11-14
1235611724 Katherine Winstead Knott Counselor 3460 Summit Ridge Parkway, Suite 503, Duluth, GA 30096 2018-08-31
1710467857 Envision Optics LLC Optometrist 1943 Pleasant Hill Rd, Duluth, GA 30096 2018-08-17
1104314202 Erin Mckernan Scupham Chiropractor 3820 Pleasant Hill Rd. Ne, Suite 4, Duluth, GA 30096 2018-04-25
1053839456 Rogers Bridge Pediatric Therapy, LLC Clinic/Center 2845 Summercrest Ln, Duluth, GA 30096 2017-09-06
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Taxonomy Information

Taxonomy Code 3336M0003X
Grouping Suppliers
Classification Pharmacy
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’s covered members only.
Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new]

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1316465859 Integrated Health Solutions LLC Pharmacy 1284 Glandor Ct Se, Mableton, GA 30126-2755 2017-09-05
1174826754 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 1478 Dogwood Dr Se, Conyers, GA 30013-5088 2010-12-21
1053612119 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 205 Newnan Crossing Byp, Newnan, GA 30265-1063 2010-11-05
1881910552 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 684 Sixes Rd Ste 275, Holly Springs, GA 30115-8721 2010-04-20
1144546920 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 455 Philip Blvd Ste 130, Lawrenceville, GA 30046-8767 2010-04-19
1699003681 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 201 W Ponce De Leon Ave, Decatur, GA 30030-3217 2009-12-02
1366622912 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 8011 Mall Pkwy, Lithonia, GA 30038-2543 2007-11-13
1518090836 Northeast Georgia Health Services Pharmacy 825 Jesse Jewell Parkway Suite D, Gainesville, GA 30501-3715 2007-03-14
1578606950 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 3640 Tramore Pointe Pkwy, Austell, GA 30106-6825 2007-02-15
1568577450 Kaiser Foundation Health Plan of Georgia, Inc. Pharmacy 1745 Peachtree Rd Ne, Atlanta, GA 30309-2410 2006-08-20
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Competitor

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City DULUTH
Zip Code 30096

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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