# IMPACT PHYSICIAN GROUP, LLC

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

## Provider details

- **NPI number:** 1366262487
- **Authorized official:** PAUL MILLER (CEO)
- **Authorized official phone:** (678) 967-5599

## Contact information

- **Practice address:** 5825 HARRISON BLVD, SOUTH OGDEN, UT 84403-4316
- **Practice address phone:** (801) 475-5254
- **Mailing address:** PO BOX 744577, ATLANTA, GA 30374-4577
- **Mailing address fax:** (844) 440-2328

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/14/2024
- **Last updated:** 10/14/2024