Provider Demographics
NPI:1245409432
Name:JAZZ-ME HAIR DESIGNS, LLC
Entity type:Organization
Organization Name:JAZZ-ME HAIR DESIGNS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-256-7754
Mailing Address - Street 1:3420 E PONCE DE LEON AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30079-1202
Mailing Address - Country:US
Mailing Address - Phone:770-256-7754
Mailing Address - Fax:
Practice Address - Street 1:3420 E PONCE DE LEON AVE
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:GA
Practice Address - Zip Code:30079-1202
Practice Address - Country:US
Practice Address - Phone:770-256-7754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACOSA 037843335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier