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General NPI Number Information
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NPI Number | 1962390708
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Entity Type | Organization
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Legal Business Name | IMPACT PHYSICIAN GROUP TEXAS PHYSIATRY SERVICES LLC
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Dates
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Enumeration Date | 06/27/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 20 PINNACLE PKWY
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City | ELGIN
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State | SC
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Zip | 29045-8389
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Country | US
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Telephone | 803-438-8890
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Fax |
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Provider Business Mailing Address
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Address Line | 21 EASTBROOK BND STE 218
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1546
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Country | US
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Telephone | 678-967-5599
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PAUL MILLER
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Credential | CEO
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Telephone | 678-967-5599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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