Healthcare Provider Details

I. General information

NPI: 1750168431
Provider Name (Legal Business Name): REFINE PLASTIC AND HAND SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 TRACE COLONY PARK DR STE A
RIDGELAND MS
39157-8810
US

IV. Provider business mailing address

344 SUNDIAL RD
MADISON MS
39110-8772
US

V. Phone/Fax

Practice location:
  • Phone: 601-324-4066
  • Fax:
Mailing address:
  • Phone: 512-796-8628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROLYN ANN CUSHING
Title or Position: OWNER
Credential: MD
Phone: 512-796-8628