MC Medical LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MC MEDICAL LLC

Practice address

2510 Redmond Cir NW
Rome, GA 30165-1913

Phone

(706) 728-3246

Fax

(706) 232-6598

NPI assigned

Jul 22, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Soujanya Pulluru

Title

President

Phone

(706) 728-3246

Specialties & licenses 2

Addresses

Other names 1

• Walmart Care Clinic 10-0658 Other name

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-5203

  • Community/Retail Pharmacy
  • London, OH
  • NPI 1750308953

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638835200000",
    "number": "1174930150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445",
            "telephone_number": "479-204-8550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 REDMOND CIR NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301651913",
            "telephone_number": "706-728-3246",
            "fax_number": "706-232-6598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MC MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-22",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A",
        "authorized_official_last_name": "PULLURU",
        "authorized_official_first_name": "SOUJANYA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-728-3246"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Care Clinic 10-0658",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Charles B May Jr., M.D.
• Leslie Kara May, B.S.
• John Kelly Mayfield, MD
• Lisa Michele Mbriwa, M.A., LPC
• MC Elite Case Management LLC
• Katherine Marie McArthur
• Charles Edward McBride III, M.D.
• Deborah Lynn McBride, FNP
• James Lebron McBride, LMFT
• Enid McCarthy

• General Practice Physician in Rome, GA
• Providers in Rome, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.