Healthcare Provider Details

I. General information

NPI: 1366360331
Provider Name (Legal Business Name): CHRISTINE MARY CUSHING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 HIGHGROVE DR
FAYETTEVILLE GA
30215-6528
US

IV. Provider business mailing address

385 HIGHGROVE DR
FAYETTEVILLE GA
30215-6528
US

V. Phone/Fax

Practice location:
  • Phone: 678-633-4396
  • Fax:
Mailing address:
  • Phone: 678-633-4396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number43027
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: