Mouzon, Jacqueline Deloache

Mouzon, Jacqueline Deloache is an individual health care provider with primary practice located at 800 N Fant St , Anderson SC 29621-5708. She recently has 3 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Neurology, Allopathic & Osteopathic Physicians / Psychiatry. Allopathic & Osteopathic Physicians / Psychiatry is her primary health care specialty. Mouzon, Jacqueline Deloache can be contacted via phone (864) 512-1000.

Contact Information

Primary practice address
800 N Fant St Anderson SC 29621-5708
Phone: (864) 512-1000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 23781 South Carolina
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 23781 South Carolina
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 23781 South Carolina

Profile Details

NPI number 1134111222
LBN Legal business name Mouzon, Jacqueline Deloache
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 16th, 2005
Last updated Jul 8th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134111222 NPPES
South Carolina MEDICAID 237817

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