| Impact Physician Group, South Carolina Llc | |
|
20 Pinnacle Pkwy Elgin SC 29045-8389 | |
| (803) 438-8890 | |
| Not Available |
| Full Name | Impact Physician Group, South Carolina Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 20 Pinnacle Pkwy, Elgin, South Carolina |
| Authorized Official Name and Position | Paul Miller (CEO) |
| Authorized Official Contact | 6789675599 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Impact Physician Group, South Carolina Llc 21 Eastbrook Bnd Ste 218 Peachtree City GA 30269-1546 Ph: (678) 967-5599 | Impact Physician Group, South Carolina Llc 20 Pinnacle Pkwy Elgin SC 29045-8389 Ph: (803) 438-8890 |
| NPI Number | 1215521752 |
|---|---|
| Provider Enumeration Date | 02/25/2021 |
| Last Update Date | 12/19/2022 |
| Medicare PECOS PAC ID | 9638579352 |
|---|---|
| Medicare Enrollment ID | O20210616002604 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215521752 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Enon Maci |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750473096 PECOS PAC ID: 7012917032 Enrollment ID: I20080715000085 |
| Provider Name | William G Mcdermott |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831485838 PECOS PAC ID: 6103140504 Enrollment ID: I20150324002481 |
| Provider Name | Rima P Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023285665 PECOS PAC ID: 0446426985 Enrollment ID: I20161214001007 |
| Provider Name | Alexei Zhadkevich |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760642268 PECOS PAC ID: 5698078533 Enrollment ID: I20180716000364 |
| Provider Name | Christine C Cannon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366918708 PECOS PAC ID: 3072851245 Enrollment ID: I20190213001754 |
| Provider Name | Zubair Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134416019 PECOS PAC ID: 0840410403 Enrollment ID: I20210106000738 |
| Provider Name | Jibran K Durrani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750797262 PECOS PAC ID: 8527378850 Enrollment ID: I20210106001560 |
| Provider Name | Saif Choudhury |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447540943 PECOS PAC ID: 7012133812 Enrollment ID: I20210106002007 |
| Provider Name | Kamran Quraishi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417175068 PECOS PAC ID: 0648361568 Enrollment ID: I20210106002180 |
| Provider Name | Sheryar Sarwar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730426958 PECOS PAC ID: 0941500714 Enrollment ID: I20210106002709 |
| Provider Name | Jennie Dawson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083204390 PECOS PAC ID: 3870908171 Enrollment ID: I20210218003028 |
| Provider Name | Haris Adnan Siraj |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982045902 PECOS PAC ID: 4183913361 Enrollment ID: I20210322000920 |
| Provider Name | Lisa Correll Fisher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417407230 PECOS PAC ID: 5496031296 Enrollment ID: I20220503001673 |
| Provider Name | Paul Ziomek |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548357908 PECOS PAC ID: 7719955343 Enrollment ID: I20230804000039 |
| Provider Name | Aamir Ghouse Mohiuddin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063040533 PECOS PAC ID: 4981029493 Enrollment ID: I20231020002619 |
| Provider Name | Lense Tessema Duresso |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578008991 PECOS PAC ID: 4284068958 Enrollment ID: I20231106000051 |
| Provider Name | Aytul Y Cremer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295417863 PECOS PAC ID: 4385092956 Enrollment ID: I20231121002459 |
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