MEDICARE: KASHEITA CLARKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471C1101X	Cardiovascular-Interventional Technology Radiologic Technologist

General Provider Information

NPI Number	:	1609701556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASHEITA CLARKE

Provider Business Mailing Address
First Line	:	255 RESERVATION WAY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-4805
Country	:	US
Telephone Number	:	347-883-1592
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 RESERVATION WAY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-4805
Country	:	US
Telephone Number	:	347-883-1592
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ KASHEITA CLARKE ” Practice Location

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