Provider Demographics
NPI:1881219046
Name:COLOR ME JAZZY
Entity Type:Organization
Organization Name:COLOR ME JAZZY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAZMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-207-5923
Mailing Address - Street 1:665 S PEAR ORCHARD RD STE 106-560
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4861
Mailing Address - Country:US
Mailing Address - Phone:662-207-5923
Mailing Address - Fax:662-635-5155
Practice Address - Street 1:665 S PEAR ORCHARD RD STE 106-560
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4861
Practice Address - Country:US
Practice Address - Phone:662-207-5923
Practice Address - Fax:662-635-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-13
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier