KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC. (NPI# 1417343120) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417343120 |
| Entity Type | Organization |
| Organization Name | KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC. |
| Other Organization Name | KAISER PERMANENTE GLENLAKE CLINIC PHARMACY |
| Practice Address |
20 Glenlake Pkwy Atlanta GA 30328-3473 |
| Practice Telephone | 7706776321 |
| Practice Fax Number | 7706776320 |
| Mailing Telephone | 7706776321 |
| Mailing Fax Number | 7706776320 |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2015-04-09 |
| Authorized Official Name | DIANE SANDERS (PHARMACY COMPLIANCE MANAGER) |
| Authorized Official Telephone | 4049495336 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
PHCL000028 | GA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2145689 | 01 |
| Other Name | Type Code |
|---|---|
| Kaiser Permanente Glenlake Clinic Pharmacy | Doing Business As Name - Organization |
| 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 |
| Street Address |
20 GLENLAKE PKWY |
| City | ATLANTA |
| State | GA |
| Zip Code | 30328-3473 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487655528 | Thomas Wilson Phillips | Radiology | 20 Glenlake Pkwy, Radiation Oncology, Atlanta, GA 30328 | 2005-08-10 |
| 1659998177 | Jamie Elizabeth Coates | Pharmacist | 20 Glenlake Pkwy, Atlanta, GA 30328-3431 | 2020-06-30 |
| 1891335014 | Jenna R Van Zelfden | Nurse Practitioner | 20 Glenlake Pkwy, Atlanta, GA 30328-3473 | 2020-01-15 |
| 1346801362 | Chisom Chijioke Odogwu | Physician Assistant | 20 Glenlake Pkwy, Atlanta, GA 30328-3473 | 2019-06-21 |
| 1790269579 | Lauren Erin Holcomb | Physician Assistant | 20 Glenlake Pkwy, Atlanta, GA 30328-3473 | 2018-09-18 |
| 1528592094 | Kurtis Bertram | Podiatrist | 20 Glenlake Pkwy, Atlanta, GA 30328-3473 | 2017-04-12 |
| 1598111536 | Tiffany Casper | Advanced Practice Midwife | 20 Glenlake Pkwy, Atlanta, GA 30328 | 2016-05-09 |
| 1538419726 | James Joseph Weigel | Social Worker | 20 Glenlake Pkwy, Behavioral Health, Atlanta, GA 30328 | 2012-09-14 |
| 1053674903 | Yi-jou Tsai | Psychiatry & Neurology | 20 Glenlake Pkwy, Atlanta, GA 30328-3473 | 2012-06-15 |
| 1912264029 | Andrea Lynn Ledbetter | Physician Assistant | 20 Glenlake Pkwy, Kaiser Permanente Glenlake Dept of Gastroenterology, Atlanta, GA 30328 | 2012-04-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467910042 | Amber Andrews | Behavior Technician | 750 Hammond Drive Bldg 7 Suite 100, Atlanta, GA 30328 | 2019-03-04 |
| 1215492830 | Ryan William Dubinin | Behavior Technician | 750 Hammond Drive, Building 7, Suite 100, Atlanta, NJ 30328 | 2019-02-07 |
| 1346710142 | Emily Rose Lloyd Swavely | Speech-Language Pathologist | 5825 Glenridge Rd., Building 1, Suite 133, Atlanta, GA 30328 | 2018-12-05 |
| 1063994481 | Mark Edward Brachmanski | Optometrist | 800 Mount Vernon Highway Ne, Suite 130, Atlanta, GA 30328 | 2018-09-01 |
| 1407352578 | Nina Brown | Massage Therapist | 7100 Peachtree Dunwoody Rd Ste 110, Sandy Springs, GA 30328 | 2018-04-05 |
| 1336657741 | Renee Usher Reeves | Assistant Behavior Analyst | 750 Hammond Dr Building 7, Suite 100, Atlanta, GA 30328 | 2018-01-19 |
| 1487168274 | Patricia Nicole Felder | Student in an Organized Health Care Education/Training Program | 270 Carpenter Dr, Ne, Suite # 400, Atlanta, GA 30328 | 2017-12-01 |
| 1447762927 | Ponders Podiatry LLC | Podiatrist | 275 Carpenter Drive Ne, Suite 106, Atlanta, GA 30328 | 2017-10-24 |
| 1770093601 | Syed M Rasheed | Physician Assistant | 5788 Roswell Rd Ste 100, Atlanta, GA 30328 | 2017-10-05 |
| 1437678190 | Jeanette Denise Jones | Counselor | 270 Carpenter Drive, Suite 400, Sandy Springs, GA 30328 | 2017-09-13 |
| Find all providers in zip 30328 | ||||
| Taxonomy Code | 3336C0002X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Clinic Pharmacy |
| A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |
| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124598362 | Grady Memorial Hospital Corporation | Pharmacy | 80 Jesse Hill Jr Dr Se Rm 10b-043, Atlanta, GA 30303-3031 | 2018-11-30 |
| 1841335882 | Kirkwood Mental Health Center Pharmacy | Pharmacy | 23 Warren St Se, Atlanta, GA 30317-2201 | 2007-02-20 |
| 1043306681 | Howell Mill Pharmacy Inc | Pharmacy | 1970 Howell Mill Rd Nw, Atlanta, GA 30318-2519 | 2006-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265974455 | Counseling Solutions of Chatsworth, LLC | Pharmacy | 1289 Gi Maddox Pkwy, Chatsworth, GA 30705-2069 | 2016-11-05 |
| 1912367111 | Carrollton Orthopaedic Clinic PC | Pharmacy | 812 S Park St Ste 3, Carrollton, GA 30117-4412 | 2016-03-01 |
| 1013376490 | Carrollton Orthopaedic Clinic PC | Pharmacy | 204 Allen Memorial Dr Ste 102, Bremen, GA 30110-2063 | 2016-02-15 |
| 1861791246 | New Start Treatment, LLC | Pharmacy | 1615 Highway 19 N, User, Thomaston, GA 30286-2277 | 2011-03-24 |
| 1740584770 | Southcoast Medical Group P C | Pharmacy | 1326 Eisenhower Dr Bldg 1, Savannah, GA 31406-3928 | 2011-01-05 |
| 1235348020 | Medicine Center of Atlanta | Pharmacy | 3646 Chamblee Tucker Rd, Suite C, Chamblee, GA 30341-4406 | 2007-05-21 |
| 1700099454 | Curtis V. Cooper Primary Health Care, Inc. | Pharmacy | 106 E. Broad St., Savannah, GA 31401-2917 | 2007-05-08 |
| 1720187602 | Forest Heights Phcy Inc | Pharmacy | Hlth Svcs Bldg, Watson Hall, Statesboro, GA 30460-0001 | 2006-09-21 |
| 1811902448 | Middle Flint Community Board | Pharmacy | 1335 N 5th Street Ext, Cordele, GA 31015-3753 | 2006-07-30 |
| 1073568838 | Unison Behavioral Health Pharmacy | Pharmacy | 1007 Mary Street, Waycross, GA 31501 | 2006-05-23 |
| Find all providers with the same taxonomy | ||||
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| 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.