Basic Information
| Provider Information | |||||||||
| NPI: | 1932404274 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KAISER PERMANENTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3495 PIEDMONT RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303051717 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 BANKS STA | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302147507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786103700 | ||||||||
| FaxNumber: | 6786103704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2011 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | FARMER | ||||||||
| AuthorizedOfficialFirstName: | KATHERINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF LABORATORY SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 4043099314 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 11D2017908 | GA | N | Laboratories | Clinical Medical Laboratory | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.