Impact Physician Group Nephrology, LLC
Internal Medicine, Nephrology in Lebanon, IN. Organization (NPI-2).
NPI number1003704875
StatusActive
Last updated in NPPESJul 28, 2025
Details
- NPI
- 1003704875
- Entity type
- Organization (NPI-2)
- Legal business name
- Impact Physician Group Nephrology, LLC
- Organization subpart
- No
- Enumeration date
- Jun 27, 2025
- Certification date
- Jul 28, 2025
- Last updated
- Jul 28, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RN0300X | Internal Medicine, Nephrology | – | – | Yes |
Practice location
1585 Perry Worth RdLebanon, IN 46052-9635
Phone 765-482-6391
Mailing address
21 Eastbrook Bnd Ste 218Peachtree City, GA 30269-1546
Phone 678-967-5599 · Fax 678-603-9843
Authorized official
Paul Miller
Ceo
6786994977
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