Provider Demographics
NPI:1376510289
Name:LARTEY, KINGSLEY ASAMOAH (DO)
Entity type:Individual
Prefix:DR
First Name:KINGSLEY
Middle Name:ASAMOAH
Last Name:LARTEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:
Practice Address - Street 1:1370 W D ST
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3506
Practice Address - Country:US
Practice Address - Phone:336-651-8100
Practice Address - Fax:336-716-0030
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008576207R00000X
SC36173207R00000X, 208M00000X
NC2018-02663207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01316207OtherRAILROAD MEDICARE
SC361735Medicaid
OH2612211Medicaid
OHLA4164561Medicare ID - Type Unspecified
SCSC17329068Medicare PIN
SC361735Medicaid
SCSC17325019Medicare PIN