KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC. (NPI# 1861817017) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861817017 |
| Entity Type | Organization |
| Organization Name | KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC. |
| Other Organization Name | KAISER PERMANENTE SOUTHWOOD CLINIC PHARMACY |
| Practice Address |
2400 Mount Zion Pkwy Jonesboro GA 30236-2500 |
| Practice Telephone | 7706034242 |
| Practice Fax Number | 7706034243 |
| Mailing Telephone | 7706034242 |
| Mailing Fax Number | 7706034243 |
| Enumeration Date | 2014-02-25 |
| Last Update Date | 2016-12-20 |
| 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 | ||
| N | 3336M0003X |
Pharmacy Specialization: Managed Care Organization Pharmacy |
Suppliers | ||
| Y | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
PHCL000025 | GA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2144375 | 01 |
| Other Name | Type Code |
|---|---|
| Kaiser Permanente Southwood 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 |
2400 MOUNT ZION PKWY |
| City | JONESBORO |
| State | GA |
| Zip Code | 30236-2500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871568303 | David W Lazan | Urology | 2400 Mount Zion Pkwy, Jonesboro, GA 30236-2500 | 2006-02-20 |
| 1033721113 | Hannah Yael Paull | Psychologist | 2400 Mount Zion Pkwy, Jonesboro, GA 30236-2500 | 2020-08-19 |
| 1497316343 | Alexandra Blackburn | Nurse Practitioner | 2400 Mount Zion Pkwy, Jonesboro, GA 30236-2500 | 2019-06-21 |
| 1811459944 | Lisa Fraser-powell | Social Worker | 2400 Mount Zion Pkwy, Jonesboro, GA 30236-2500 | 2019-04-06 |
| 1093244220 | Megan Deanne Griffin | Physician Assistant | 2400 Mount Zion Pkwy, Jonesboro, GA 30236-2500 | 2017-06-10 |
| 1104358803 | Simone Keinia Sharp-bucknor | Registered Nurse | 2400 Mount Zion Pkwy, Jonesboro, GA 30236-2500 | 2017-03-31 |
| 1740712454 | Lisa Pruitt | Registered Nurse | 2400 Mount Zion Pkwy, Jonesboro, GA 30236-2500 | 2017-03-31 |
| 1063952752 | Kayla Randle | Pharmacist | 2400 Mount Zion Pkwy, Suite 116, Jonesboro, GA 30236-2500 | 2017-03-01 |
| 1952849531 | Anna Broadus | Nurse Practitioner | 2400 Mount Zion Pkwy, Jonesboro, GA 30236-2500 | 2017-02-03 |
| 1649656653 | Hector George Clarke Jr. | Pharmacist | 2400 Mount Zion Pkwy, Jonesboro, GA 30236-2500 | 2015-08-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972123362 | Life Source Counseling & Consulting, LLC | Clinic/Center | 118 North Avenue, Suite A, Jonesboro, GA 30236 | 2020-04-25 |
| 1639609555 | New Beginnings Behavioral Counseling,llc | Social Worker | 9456 S Main St Ste E2, Jonesboro, GA 30236 | 2017-06-13 |
| 1437696762 | Clarissa Alexandra Poole | Counselor | 2106 Fair Ridge Ct, Jonesboro, GA 30236 | 2017-01-25 |
| 1588012892 | Sundance Healthcare Service Inc | In Home Supportive Care | 7861 Collinswood Court, Jonesboro, GA 30236 | 2016-05-26 |
| 1942669205 | Adrianne Smiley Gurley | Occupational Therapist | 1299 Battlecreek Rd Ste 210, Jonesboro, GA 30236 | 2016-02-15 |
| 1336505809 | Integrated Health Center | Dentist | 8600 Tara Blvd, Suite D, Jonesboro, GA 30236 | 2016-01-13 |
| 1467827402 | Surrell Porter | Nurse Practitioner | 1287 Georgia Highway 138 Spur, Suite 8, Jonesboro, GA 30236 | 2015-12-02 |
| 1740688910 | Jacqueline Carolyn Edwards | Registered Nurse | 8081 Tara Blvd, 265, Jonesboro, GA 30236 | 2014-12-19 |
| 1770991861 | Lower Extremity Diagnostics, LLC | Podiatrist | 6911 Tara Boulevard, Jonesboro, GA 30236 | 2014-08-01 |
| 1760899710 | Fresenius Medical Care Jonesboro, LLC | Clinic/Center | 8060 Summitt Business Parkway, Jonesboro, GA 30236 | 2014-07-22 |
| Find all providers in zip 30236 | ||||
| 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 |
|---|---|---|---|---|
| 1528451648 | St. Bernards Hospital Inc | Pharmacy | 225 E Washington Ave, Jonesboro, AR 72401-3111 | 2015-03-13 |
| 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 |
| 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 |
| 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.