Provider Demographics
NPI:1265320055
Name:IMPACT PHYSICIAN GROUP, TENNESSEE LLC
Entity type:Organization
Organization Name:IMPACT PHYSICIAN GROUP, TENNESSEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:678-967-5599
Mailing Address - Street 1:21 EASTBROOK BND STE 218
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1546
Mailing Address - Country:US
Mailing Address - Phone:789-675-5599
Mailing Address - Fax:678-603-9843
Practice Address - Street 1:1240 S GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2226
Practice Address - Country:US
Practice Address - Phone:901-275-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty