# MC MEDICAL LLC

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

## Provider details

- **NPI number:** 1851042238
- **Authorized official:** SOUJANYA PULLURU (OWNER)
- **Authorized official phone:** (479) 204-1258

## Contact information

- **Practice address:** 1586 BRANAN FIELD RD, MIDDLEBURG, FL 32068-8427
- **Practice address phone:** (904) 406-6303
- **Mailing address:** 702 SW 8TH ST \# MS 0445, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 204-1258
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 103T00000X | Psychologist | — | — | — |
| 104100000X | Social Worker | — | — | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | — | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |
| 231H00000X | Audiologist | — | — | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/17/2022
- **Last updated:** 01/17/2022