# IMPACT PHYSICIAN GROUP, LOUISIANA LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1437775459
- **Authorized official:** PAUL MILLER (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (260) 407-8009

## Contact information

- **Practice address:** 2720 RUE DE JARDIN STE 100, LAKE CHARLES, LA 70605-4050
- **Practice address phone:** (260) 407-8009
- **Practice address fax:** (260) 407-8009
- **Mailing address:** 21 EASTBROOK BND STE 218, PEACHTREE CITY, GA 30269-1546
- **Mailing address phone:** (260) 407-8009
- **Mailing address fax:** (260) 407-8009

## Taxonomy

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

## Other

- **Enumeration date:** 06/25/2020
- **Last updated:** 06/25/2020