Provider Demographics
NPI:1932510088
Name:JIRAH CREATIONS
Entity Type:Organization
Organization Name:JIRAH CREATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELESHIA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED HAIR LOSS
Authorized Official - Phone:404-840-6565
Mailing Address - Street 1:7285 MEADOW POINT DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-6350
Mailing Address - Country:US
Mailing Address - Phone:404-840-6565
Mailing Address - Fax:770-680-5563
Practice Address - Street 1:7285 MEADOW POINT DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-6350
Practice Address - Country:US
Practice Address - Phone:404-840-6565
Practice Address - Fax:770-680-5563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty