Provider Demographics
NPI:1740484302
Name:CUSHING, CAROLYN ANN (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:ANN
Last Name:CUSHING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 SUNDIAL RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8772
Mailing Address - Country:US
Mailing Address - Phone:512-796-8628
Mailing Address - Fax:
Practice Address - Street 1:281 TRACE COLONY PARK DR STE A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8810
Practice Address - Country:US
Practice Address - Phone:601-345-1090
Practice Address - Fax:601-642-3272
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS229442082S0105X
TXN7411208200000X
TXBP1-00269112086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2406418Medicaid
MS06906031Medicaid
3872487469OtherMYUTMB 3872487469-COMMERCIAL NUMBER
AL175653Medicaid
AL175653Medicaid