Individual
DR. SUSIE BOULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1030 JEFFERSON AVE, MEMPHIS, TN 38104-2127
(901) 523-8990
Mailing address
9355 GRESHAM CV, GERMANTOWN, TN 38139-3596
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
27769
TN
Other
Enumeration date
08/09/2006
Last updated
07/08/2007
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