Born Ida Prather in Toccoa, Georgia, she left home at fourteen to tour with a minstrel revue. Cox excelled at vaudeville singing, but when the popularity of vaudeville shows began to fade, she transformed herself into a formidable blues singer and worked the Southern tent show and vaudeville circuit. She spent some time with pianist Jelly Roll Morton before signing a recording contract with Paramount in 1923.
In 1923 she made her first blues recordings, Graveyard Dream Blues and Weary Way Blues, for the Paramount label. She met with immediate success and went on to record seventy-eight songs between 1923 and 1929, including Cemetery Blues, Handy Man, and her best-known song, Wild Women Don't Have the Blues. Cox wrote most of the songs that she recorded.
Many of the seventy- eight songs Cox recorded for the label through 1929, and with other labels like Broadway and Silvertone (using pseudonyms such as Kate Lewis, Velma Bradley, Julia Powers, and Jane Smith) dealt with themes aimed at female audiences. Ida seemed to sing directly to Black women who saw themselves trapped by demeaning racial and social conditions, yet longed for dignity and respect, especially from the men in their lives. One of Cox's most enduring songs, Wild Women Don't Have the Blues, hinted at sexual freedom. Two other Cox classics, Pink Slip Blues which dealt with the woes of unemployment, and Last Mile Blues a song about capital punishment, revealed a decidedly female view of social issues.