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| Type | Legal entity | [sources] | |||
|---|---|---|---|---|---|
| Name | Azomani, Hosan | [sources] | |||
| Legal form | not available | [sources] | |||
| Country | United States | [sources] | |||
| NPI | 1457342388 | [sources] | |||
| Sector | Pediatrics | [sources] | |||
| Status | not available | [sources] | |||
| Address | 559 Arnold Avenue , Suite A , Greenville, MS 38701 | [sources] | |||
| Last change | Last processed | First seen | |||
Service providers who have been terminated for cause from Mississippi's Medicaid program.
United States · Mississippi Division of Medicaid
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