Provider Demographics
NPI:1619149739
Name:SYMED NC, LLC
Entity Type:Organization
Organization Name:SYMED NC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RADWAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KHURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-273-2360
Mailing Address - Street 1:3150 LENOX PARK BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-4299
Mailing Address - Country:US
Mailing Address - Phone:901-273-2350
Mailing Address - Fax:901-273-2351
Practice Address - Street 1:3150 LENOX PARK BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4299
Practice Address - Country:US
Practice Address - Phone:901-273-2350
Practice Address - Fax:901-273-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002015972084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2011763AMedicare PIN