Provider Demographics
NPI:1891791471
Name:RILEY, LOUIS T (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:T
Last Name:RILEY
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 1:300 STONECREST BLVD
Mailing Address - Street 2:STE 490
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6817
Mailing Address - Country:US
Mailing Address - Phone:615-223-0200
Mailing Address - Fax:615-223-8704
Practice Address - Street 1:300 STONECREST BLVD
Practice Address - Street 2:STE 490
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6817
Practice Address - Country:US
Practice Address - Phone:615-223-0200
Practice Address - Fax:615-223-8704
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2024-03-25
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-20
Provider Licenses
StateLicense IDTaxonomies
KY21439207V00000X
TN26222207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3089664Medicaid
TN3726680Medicaid
TN3726680Medicaid
TN3089664Medicaid
TN3726680Medicare ID - Type UnspecifiedGROUP PRICING NUMBER