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General NPI Number Information
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NPI Number | 1811403207
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Entity Type | Organization
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Legal Business Name | PREMIER ANESTHESIA OF GEORGIA LLC
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 12/20/2017
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Provider Practice Location Address
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Address Line | 11 UPPER RIVERDALE RD
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City | RIVERDALE
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State | GA
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Zip | 30274
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Country | US
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Telephone | 770-991-8000
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Fax | 404-941-1264
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Provider Business Mailing Address
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Address Line | 500 NORTHRIDGE RD STE 330
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City | ATLANTA
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State | GA
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Zip | 30350-3314
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Country | US
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Telephone | 404-941-1291
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Fax | 404-941-1264
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Authorized Official
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Title or Position | VICE PRESIDENT OF REVENUE CYCLE
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Name | RICHARD POSEY
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Credential |
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Telephone | 404-941-1261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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