# PREMIER ANESTHESIA OF MONTGOMERY PC

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

## Provider details

- **NPI number:** 1780636233
- **Authorized official:** RANDY WALKER (VP FINANCE)
- **Authorized official phone:** (678) 690-7812

## Contact information

- **Practice address:** 2105 EAST SOUTH BLVD, MONTGOMERY, AL 36116
- **Practice address phone:** (770) 643-5500
- **Practice address fax:** (404) 941-1304
- **Mailing address:** 2655 NORTHWINDS PKWY, ALPHARETTA, GA 30009-2280
- **Mailing address phone:** (855) 220-3662

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | — |
| 207L00000X | Anesthesiology Physician | — | AL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |
| 367H00000X | Anesthesiologist Assistant | — | NULL | — |
| 367H00000X | Anesthesiologist Assistant | — | — | — |

## Other

- **Enumeration date:** 05/16/2006
- **Last updated:** 05/13/2026