Organization
MC MEDICAL LLC
Active
Other names
Walmart Care Clinic 10-1153
Organization subpart
No
Provider details
NPI number
Authorized official
SOUJANYA PULLURU (PRESIDENT)
(479) 703-0468
Entity
Organization
Contact information
Practice address
6020 HARRISON RD, MACON, GA 31206-4742
(478) 703-0468
(478) 784-9118
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
07/21/2014
Last updated
12/07/2021
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