KAISER PERMANENTE INTERNAL (NPI# 1205872686) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205872686 |
| Entity Type | Organization |
| Organization Name | KAISER PERMANENTE INTERNAL |
| Practice Address |
200 Cres Ctr Pkwy Tucker GA 30084-7047 |
| Practice Telephone | 7704963623 |
| Practice Fax Number | 7704963528 |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2007-07-19 |
| Authorized Official Name | DIANE SANDERS HARVEY (PHCY COMPLIANCE MGR GA) |
| Authorized Official Telephone | 4049495336 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336M0003X |
Pharmacy Specialization: Managed Care Organization Pharmacy |
07798 | GA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OTHER ID NUMBER | 1141023 | 01 | |
| OTHER ID NUMBER-COMMERCIAL NUMBER | 1141023 | 01 |
| Street Address |
200 CRES CTR PKWY |
| City | TUCKER |
| State | GA |
| Zip Code | 30084-7047 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023110053 | Katrina R Bader | Nurse Practitioner | 200 Cres Ctr Pkwy, Department of Research, Tucker, GA 30084-7047 | 2006-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609401355 | Excellent Medical Transport | Ambulance | 4378 Sentry Dr, Tucker, GA 30084 | 2020-03-03 |
| 1811468796 | Caleb Lee Ebbets | Physical Therapist | 1459 Montreal Road, Medical Office Building, Suite 301, Tucker, GA 30084 | 2018-12-17 |
| 1417436130 | Benjamin Han Wook Chong | Physical Therapist | 1460 Montreal Road East, Suite 300, Tucker, GA 30084 | 2018-08-13 |
| 1336659325 | Lavista Acupuncture and Herbal Medicine | Acupuncturist | 4915 Lavista Rd, Tucker, GA 30084 | 2017-10-04 |
| 1699294207 | Debrica Butler | Counselor | 1021 Oak Chase Dr., Apt C, Tucker, GA 30084 | 2017-09-14 |
| 1295264695 | Jolanta Wazgowska Hopkins | Social Worker | 4404 Idlewood Lane, Tucker, GA 30084 | 2017-06-08 |
| 1164956157 | Sage Dental Group of Georgia LLC | Dentist | 4320 Lavista Rd, Suite C119, Tucker, GA 30084 | 2017-04-17 |
| 1689107807 | Mashail Manzur | Podiatrist | 1460 Montreal Rd E, Ste 275, Tucker, GA 30084 | 2017-04-05 |
| 1053765578 | Jessica Spruyt | Speech-Language Pathologist | 3756 Lavista Rd Suite 104, Tucker, GA 30084 | 2016-04-21 |
| 1265802318 | Spine and Orthopedics of Atlanta, LLC | Clinic/Center | 1462 Montreal Rd Ste 218, Tucker, GA 30084 | 2015-10-01 |
| Find all providers in zip 30084 | ||||
| Taxonomy Code | 3336M0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Managed Care Organization Pharmacy |
| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578678462 | Kaiser Foundation Health Plan of Georgia, Inc. | Pharmacy | 200 Crescent Center Pkwy, Tucker, GA 30084-7047 | 2006-08-20 |
| 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 |
| 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.