Individual
DR. JACQUELINE DELOACHE MOUZON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
800 N FANT ST, ANDERSON, SC 29621-5708
(864) 512-1000
Mailing address
PO BOX 100174, COLUMBIA, SC 29202-3174
(864) 512-1000
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
23781
SC
2084N0400X
Neurology Physician
23781
SC
2084P0800X
Psychiatry Physician
Primary
23781
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
237817
—
SC
Enumeration date
08/16/2005
Last updated
07/08/2021
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