# PREMIER ANESTHESIA OF VIRGINIA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255986147
- **Authorized official:** MR. RANDY WALKER (VICE PRESIDENT FINANCE)
- **Authorized official phone:** (678) 690-7812

## Contact information

- **Practice address:** 2300 OPITZ BLVD, WOODBRIDGE, VA 22191-3311
- **Practice address phone:** (404) 941-1210
- **Mailing address:** 2655 NORTHWINDS PKWY, ALPHARETTA, GA 30009-2280

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |
| 367H00000X | Anesthesiologist Assistant | — | NULL | — |
| 367H00000X | Anesthesiologist Assistant | — | — | — |

## Other

- **Enumeration date:** 08/07/2019
- **Last updated:** 02/13/2024