Healthcare Provider Details

I. General information

NPI: 1245409432
Provider Name (Legal Business Name): JAZZ-ME HAIR DESIGNS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 E PONCE DE LEON AVE
SCOTTDALE GA
30079-1202
US

IV. Provider business mailing address

3420 E PONCE DE LEON AVE
SCOTTDALE GA
30079-1202
US

V. Phone/Fax

Practice location:
  • Phone: 770-256-7754
  • Fax:
Mailing address:
  • Phone: 770-256-7754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCOSA 037843
License Number StateGA

VIII. Authorized Official

Name: CONSTANCE ELAINE JAMISON
Title or Position: OWNER/ GENERAL MANAGER
Credential:
Phone: 770-256-7754