Healthcare Provider Details

I. General information

NPI: 1336230531
Provider Name (Legal Business Name): MARGARET B. SOUSOULAS CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 BELHAVEN ST
MEMPHIS TN
38117-2320
US

IV. Provider business mailing address

186 BELHAVEN ST
MEMPHIS TN
38117-2320
US

V. Phone/Fax

Practice location:
  • Phone: 901-682-6569
  • Fax:
Mailing address:
  • Phone: 901-682-6569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number20455
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: