Healthcare Provider Details

I. General information

NPI: 1891791471
Provider Name (Legal Business Name): LOUIS T RILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date: 03/17/2006
Reactivation Date: 04/20/2006

III. Provider practice location address

300 STONECREST BLVD STE 490
SMYRNA TN
37167-6817
US

IV. Provider business mailing address

300 STONECREST BLVD STE 490
SMYRNA TN
37167-6817
US

V. Phone/Fax

Practice location:
  • Phone: 615-223-0200
  • Fax: 615-223-8704
Mailing address:
  • Phone: 615-223-0200
  • Fax: 615-223-8704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number21439
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number26222
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: