Individual ProviderSusie BoulosSpecialistOther Service ProvidersPractice Address1030 Jefferson Ave, Memphis, TN 38104-2127(901) 523-8990PECOS EnrollmentBased on the most recent information from CMS, provider Susie Boulos does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1174533145Provider TypeIndividualFull NameBoulos, SusieTitleDr.CredentialM.D.GenderFemaleSole ProprietorNoEnumeration Date8/9/2006Last Updated7/8/2007Contact InformationPractice LocationPractice Address1030 Jefferson Ave, Memphis, TN 38104-2127Phone(901) 523-8990FaxUnlisted FaxMailing LocationMailing Address9355 Gresham Cv, Germantown, TN 38139-3596PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode174400000XPrimaryDescriptionSpecialistOther Service ProvidersLicense27769Tennessee