Provider Demographics
NPI:1952119695
Name:CUSHING, MAGDALENE BROOKE (PA)
Entity type:Individual
Prefix:MISS
First Name:MAGDALENE
Middle Name:BROOKE
Last Name:CUSHING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 FLEETWOOD DR SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6119
Mailing Address - Country:US
Mailing Address - Phone:256-280-8183
Mailing Address - Fax:
Practice Address - Street 1:590 NANCY ST NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1334
Practice Address - Country:US
Practice Address - Phone:770-423-0395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical