Individual
JACQUELINE MORAA MOGUSU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4541 N JOSEY LN STE 110, CARROLLTON, TX 75010-4622
(469) 788-8588
(469) 788-7800
Mailing address
PO BOX 12187, AUGUSTA, GA 30914-2187
(706) 863-9595
(706) 868-8375
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
AP138452
TX
208D00000X
General Practice Physician
Primary
AP138452
TX
363LF0000X
Family Nurse Practitioner
AP138452
TX
Other
Enumeration date
11/12/2018
Last updated
07/16/2024
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