# MC MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356907695
- **Authorized official:** SOUJANYA PULLURU (PRESIDENT)
- **Authorized official phone:** (770) 863-7200

## Contact information

- **Practice address:** 3615 CHARLES HARDY PKWY STE 200, DALLAS, GA 30157-9472
- **Practice address phone:** (770) 863-7200
- **Practice address fax:** (770) 505-5690
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (770) 863-7200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | — | — |
| 104100000X | Social Worker | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |
| 231H00000X | Audiologist | — | — | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/13/2019
- **Last updated:** 12/14/2021