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| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Creel Cornwell | [sources] | |||
| Birth date | not available | [sources] | |||
| Nationality | not available | [sources] | |||
| Country | United States | [sources] | |||
| First name | Creel | [sources] | |||
| Last name | Cornwell | [sources] | |||
| NPI | 1265469472 | [sources] | |||
| Address | 120 Medical Park Drive, Suite 300, Bridgeport, WV 26330 | [sources] | |||
| Last change | Last processed | First seen | |||
Medicaid providers sanctioned in West Virginia's Medicaid program.
United States of America · MMIS
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| Sanctions | |||||
|---|---|---|---|---|---|
| Country | Authority | Program | Start date | End date | |
| United States | Medicaid Management Information System | - | |||
| Address | ||
|---|---|---|
| Full address | Country | |
| 120 Medical Park Drive, Suite 300, Bridgeport, WV 26330 | United States | |