Healthcare Provider Details

I. General information

NPI: 1447180484
Provider Name (Legal Business Name): MR. CURTIS ANTHONY CLARK III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 FITCH ST SE APT T3
WASHINGTON DC
20019-5916
US

IV. Provider business mailing address

2314 16TH ST SE APT 5
WASHINGTON DC
20020-4314
US

V. Phone/Fax

Practice location:
  • Phone: 202-386-1827
  • Fax:
Mailing address:
  • Phone: 202-386-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number3747P1801X
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: