Provider Demographics
NPI:1760496228
Name:KESSEY, RICHARD KWASI AGBEKO (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:KWASI AGBEKO
Last Name:KESSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7385 WALTON WAY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6555
Mailing Address - Country:US
Mailing Address - Phone:678-715-0476
Mailing Address - Fax:
Practice Address - Street 1:400 MATTHEW ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1644
Practice Address - Country:US
Practice Address - Phone:740-376-1994
Practice Address - Fax:740-374-4961
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058260207R00000X
SC29588207R00000X
MS19741208M00000X
OH35087430208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810013142Medicaid
OH2701455Medicaid
MS07307080Medicaid
7436906OtherAETNA
MSP00431576OtherRAILROAD MEDICARE
MS07307080Medicaid