Organization
MC MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOUJANYA PULLURU (PRESIDENT)
(904) 365-2555
Entity
Organization
Contact information
Practice address
7075 COLLINS RD UNIT 100, JACKSONVILLE, FL 32244-5041
(904) 365-2555
(904) 772-1575
Mailing address
702 SW 8TH ST # MS 0445, BENTONVILLE, AR 72716-0445
(479) 204-1258
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
208D00000X
General Practice Physician
Primary
—
—
231H00000X
Audiologist
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
08/24/2021
Last updated
06/16/2022
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