Organization
IMPACT PHYSICIAN GROUP, PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL MILLER (CEO)
(678) 967-5599
Entity
Organization
Contact information
Practice address
2720 RUE DE JARDIN STE 100, LAKE CHARLES, LA 70605-4050
(260) 407-8009
(260) 407-8009
Mailing address
21 EASTBROOK BND STE 218, PEACHTREE CITY, GA 30269-1546
(678) 967-5599
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
06/25/2020
Last updated
03/15/2022
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