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NPI Code Detail

MEDICARE: DR. JOANNA MILLER STOREY M.D.

MEDICARE: DR. JOANNA MILLER STOREY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician16221MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962513267
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOANNA MILLER STOREY M.D.
Provider Business Mailing Address
First Line : 1867 CRANE RIDGE DR STE 101B
Second Line :
City : JACKSON
State : MS
Zip : 39216-4956
Country : US
Telephone Number : 601-362-8776
Fax Number : 601-354-8786
Provider Business Practice Location Address
First Line : 1867 CRANE RIDGE DR STE 101B
Second Line :
City : JACKSON
State : MS
Zip : 39216-4956
Country : US
Telephone Number : 601-362-8776
Fax Number : 601-354-8786
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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