Healthcare Provider Details

I. General information

NPI: 1548183486
Provider Name (Legal Business Name): KASHA LYNN BENTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 HAY MEADOW DR
AUGUSTA GA
30909-9049
US

IV. Provider business mailing address

989 HAY MEADOW DR
AUGUSTA GA
30909-9049
US

V. Phone/Fax

Practice location:
  • Phone: 706-361-1268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number279078
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: