Organization
MC MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOUJANYA PULLURU (OWNER)
(479) 204-1258
Entity
Organization
Contact information
Practice address
1586 BRANAN FIELD RD, MIDDLEBURG, FL 32068-8427
(904) 406-6303
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
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
Primary
—
—
231H00000X
Audiologist
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
01/17/2022
Last updated
01/17/2022
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