NPIMap

Organization Active NPI

Premier Anesthesia of Montgomery PC

  • Anesthesiology Physician
  • Montgomery, AL
National Provider Identifier
1780636233
Registry record updated May 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
PREMIER ANESTHESIA OF MONTGOMERY PC
Practice address
2105 East South Blvd
Montgomery, AL 36116
Phone
(770) 643-5500
Fax
(404) 941-1304
NPI assigned
May 16, 2006
Last updated
May 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Randy Walker
Title
VP Finance
Phone
(678) 690-7812

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X NU
Anesthesiologist Assistant 367H00000X NU
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X NU
Anesthesiology Physician 207L00000X AL Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X NU

Addresses

Primary practice location

2105 East South Blvd
Montgomery, AL 36116

Mailing address

2655 Northwinds Pkwy
Alpharetta, GA 30009-2280
Phone (855) 220-3662

Other practice location 1

4340 Kings Way
Valdosta, GA 31602-6921
Phone (877) 427-7775

Other practice location 2

400 Taylor Rd
Montgomery, AL 36117-3512
Phone (404) 941-1210

Other practice location 3

6262 Veterans Pkwy
Columbus, GA 31909-3540
Phone (877) 427-7775

Other practice location 4

124 S Memorial Dr
Prattville, AL 36067-3619
Phone (404) 941-1210

Other practice location 5

470 Taylor Rd Ste 100
Montgomery, AL 36117-3532
Phone (334) 290-4530

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040105000491 AL Part B Supplier - Clinic/Group Practice 5799684148 Receives reassigned benefits from 193 practitioners
Practice locations: Montgomery, AL

National Provider Directory

National Provider Directory
Tax ID family
Premier Anesthesia of Montgomery3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 291

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 291

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778630400000",
    "number": "1780636233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 NORTHWINDS PKWY",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300092280",
            "telephone_number": "855-220-3662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 EAST SOUTH BLVD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "36116",
            "telephone_number": "770-643-5500",
            "fax_number": "404-941-1304"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4340 Kings Way",
            "address_purpose": "LOCATION",
            "city": "Valdosta",
            "state": "GA",
            "postal_code": "316026921",
            "country_code": "US",
            "telephone_number": "877-427-7775",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 Taylor Rd",
            "address_purpose": "LOCATION",
            "city": "Montgomery",
            "state": "AL",
            "postal_code": "361173512",
            "country_code": "US",
            "telephone_number": "404-941-1210",
            "fax_number": "404-941-1264",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6262 Veterans Pkwy",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "GA",
            "postal_code": "319093540",
            "country_code": "US",
            "telephone_number": "877-427-7775",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "124 S Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Prattville",
            "state": "AL",
            "postal_code": "360673619",
            "country_code": "US",
            "telephone_number": "404-941-1210",
            "fax_number": "404-941-1264",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "470 Taylor Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Montgomery",
            "state": "AL",
            "postal_code": "361173532",
            "country_code": "US",
            "telephone_number": "334-290-4530",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREMIER ANESTHESIA OF MONTGOMERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "678-690-7812"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AL",
            "license": null,
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.