Provider Demographics
NPI:1679882625
Name:CUSHMAN, CLAY BRYAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:CLAY
Middle Name:BRYAN
Last Name:CUSHMAN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MONTE SANO AVE APT B1
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6172
Mailing Address - Country:US
Mailing Address - Phone:706-825-8416
Mailing Address - Fax:
Practice Address - Street 1:2050 WALTON WAY STE 101
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4163
Practice Address - Country:US
Practice Address - Phone:706-434-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6011363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant