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Organization
IMPACT PHYSICIAN GROUP, LLC
Active
Organization
IMPACT PHYSICIAN GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL MILLER (CEO)
(678) 967-5599
Entity
Organization
Contact information
Practice address
5825 HARRISON BLVD, SOUTH OGDEN, UT 84403-4316
(801) 475-5254
Mailing address
PO BOX 744577, ATLANTA, GA 30374-4577
(844) 440-2328
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
10/14/2024
Last updated
10/14/2024
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