Individual
ELLIE BRYAN MOZINGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
125 ALPINE CIRCLE, COLUMBIA, SC 29223
(803) 779-3548
(803) 779-7055
Mailing address
125 ALPINE CIRCLE, COLUMBIA, SC 29223
(803) 779-3548
(803) 779-7055
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
15050
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150507
—
SC
05
—
400186
—
SC
01
—
582296052001
BCBS PALMETTO HEALTH
—
Enumeration date
02/17/2006
Last updated
07/20/2021
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