Organization
MC MEDICAL LLC
Active
Other names
Walmart Health
Organization subpart
No
Provider details
NPI number
Authorized official
SOUJANYA PULLURU (OWNER)
(479) 204-1258
Entity
Organization
Contact information
Practice address
1735 S HIGHWAY 27, CARROLLTON, GA 30117-8941
(770) 809-7002
(770) 838-0659
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
11/23/2022
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