Provider Demographics
NPI:1740743541
Name:JEFFERSON, CORINTHIAN SHARMEZE
Entity Type:Individual
Prefix:
First Name:CORINTHIAN
Middle Name:SHARMEZE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-2443
Mailing Address - Country:US
Mailing Address - Phone:601-325-8192
Mailing Address - Fax:
Practice Address - Street 1:920 PARK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-2443
Practice Address - Country:US
Practice Address - Phone:601-325-8192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2279P4000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P4000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPatient Transport