Provider Demographics
NPI:1114908639
Name:HOMSI, RIAD I (MD)
Entity Type:Individual
Prefix:
First Name:RIAD
Middle Name:I
Last Name:HOMSI
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:PO BOX 1798, DEPT 07-044
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-9715
Mailing Address - Country:US
Mailing Address - Phone:901-507-8675
Mailing Address - Fax:901-507-8696
Practice Address - Street 1:6373 N QUAIL HOLLOW RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-3812
Practice Address - Country:US
Practice Address - Phone:901-507-8675
Practice Address - Fax:901-507-8696
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD25479207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728303Medicaid
TN3086184Medicare ID - Type Unspecified
TNF89286Medicare UPIN