Organization
PREMIER ANESTHESIA OF PENNSYLVANIA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSANDRA HARGROVE (DELEGATED OFFICIAL/PROVIDER CORD.)
(678) 690-7808
Entity
Organization
Contact information
Practice address
501 N LANSDOWNE AVE, DREXEL HILL, PA 19026-1114
(678) 690-7808
(404) 941-1304
Mailing address
2655 NORTHWINDS PKWY, ALPHARETTA, GA 30009-2280
(770) 643-5501
(404) 941-1304
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
367H00000X
Anesthesiologist Assistant
—
—
Other
Enumeration date
01/05/2011
Last updated
08/24/2021
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