Provider Demographics
NPI:1285762880
Name:MEMPHIS PSYCHIATRIC AND ADDICTION CLINIC, PC
Entity type:Organization
Organization Name:MEMPHIS PSYCHIATRIC AND ADDICTION CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
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:901-273-2368
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:901-273-2368
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:901-273-2368
Practice Address - Fax:901-273-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3687200Medicare ID - Type UnspecifiedPHD GROUP PROVIDER #