# MC MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Walmart Care Clinic 10-1153
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285041434
- **Authorized official:** SOUJANYA PULLURU (PRESIDENT)
- **Authorized official phone:** (479) 703-0468

## Contact information

- **Practice address:** 6020 HARRISON RD, MACON, GA 31206-4742
- **Practice address phone:** (478) 703-0468
- **Practice address fax:** (478) 784-9118
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 204-8550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/21/2014
- **Last updated:** 12/07/2021