| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Story, Clifton W | [sources] | |||
| Birth date | [sources] | ||||
| Nationality | not available | [sources] | |||
| Country | United States | [sources] | |||
| NPI | 1922064591 | [sources] | |||
| Sector | Family Medicine | [sources] | |||
| Address | 106 Highland Way Suite 103 Madison, MS 39110-6930 | [sources] | |||
| Last change | Last processed | First seen | |||
Service providers who have been terminated for cause from Mississippi's Medicaid program.
United States of America · Mississippi Division of Medicaid
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