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General NPI Number Information
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NPI Number | 1982808762
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Entity Type | Individual
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Provider Name | CLAYTON GREGORY MAZOUE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 7035 SAINT ANDREWS RD
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City | COLUMBIA
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State | SC
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Zip | 29212-1177
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Country | US
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Telephone | 803-749-0924
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6069
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City | WEST COLUMBIA
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State | SC
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Zip | 29171-6069
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Country | US
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Telephone | 803-791-2203
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD.200841
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 93192
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License Number State | SC
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