Organization
MC MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOUJANYA PULLURU (PRESIDENT)
(770) 863-7200
Entity
Organization
Contact information
Practice address
3615 CHARLES HARDY PKWY STE 200, DALLAS, GA 30157-9472
(770) 863-7200
(770) 505-5690
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(770) 863-7200
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
05/13/2019
Last updated
12/14/2021
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