Provider Demographics
NPI:1851158844
Name:JAY RAW CO
Entity Type:Organization
Organization Name:JAY RAW CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUBOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-253-0115
Mailing Address - Street 1:2715 VELTRE TER SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-3144
Mailing Address - Country:US
Mailing Address - Phone:205-253-0115
Mailing Address - Fax:
Practice Address - Street 1:2715 VELTRE TER SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-3144
Practice Address - Country:US
Practice Address - Phone:205-253-0115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies