Active NPI
MC Medical LLC
- General Practice Physician
- Dallas, GA
National Provider Identifier
1356907695
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- Legal business name
- MC MEDICAL LLC
- Practice address
- 3615 Charles Hardy Pkwy Ste 200
Dallas, GA 30157-9472 - Phone
- (770) 863-7200
- Fax
- (770) 505-5690
- NPI assigned
- May 13, 2019
- Last updated
- Dec 14, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Soujanya Pulluru
- Title
- President
- Phone
- (770) 863-7200
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | NU | ||
| Psychologist | 103T00000X | NU | ||
| Social Worker | 104100000X | NU | ||
| General Practice Physician | 208D00000X | NU | Primary | |
| Audiologist | 231H00000X | NU |
Addresses
Primary practice location
3615 Charles Hardy Pkwy Ste 200
Dallas, GA 30157-9472
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (770) 863-7200
Other practice location 1
1438 Dogwood Dr. SE
Conyers, GA 30013
Phone (770) 860-8544
Other practice location 2
125 Pavilion Pkwy Ste A
Fayetteville, GA 30214-4098
Phone (770) 719-0939
Other practice location 3
4221 Atlanta Hwy Ste 101
Loganville, GA 30052-7316
Phone (704) 796-3974
Other practice location 4
210 Cobb Pkwy S Ste 100
Marietta, GA 30060-6509
Phone (770) 955-6836
Other practice location 5
137 Willow Ln
McDonough, GA 30253-6574
Phone (704) 830-4094
Other practice location 6
2042 W Spring St
Monroe, GA 30655-3164
Phone (770) 267-4175
Other practice location 7
3245 Lawrenceville Suwanee Rd Ste 100
Suwanee, GA 30024-6541
Phone (678) 482-5441
Other practice location 8
6435 Bells Ferry Rd Ste 110
Woodstock, GA 30189-2317
Phone (770) 928-0628
National Provider Directory
National Provider DirectoryLocations
3615 Charles Hardy Pkwy
Ste 200
Dallas, GA 30157
Phone (770) 767-5542
210 Cobb Pkwy S
Ste 100
Marietta, GA 30060
Phone (770) 427-9148
3245 Lawrenceville Suwanee Rd
Ste 100
Suwanee, GA 30024
Phone (678) 546-8646
Practitioners & affiliated clinicians
Practitioners 62
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Family Medicine Physician
- Morrow, GA
- NPI 1417268186
-
- Family Nurse Practitioner
- Newnan, GA
- NPI 1508300690
-
- Family Nurse Practitioner
- Cartersville, GA
- NPI 1962038307
-
- Family Nurse Practitioner
- Cedartown, GA
- NPI 1477146777
-
- Nurse Practitioner
- Atlanta, GA
- NPI 1568092518
-
- Family Medicine Physician
- Atlanta, GA
- NPI 1508206319
-
- Family Nurse Practitioner
- Holly Springs, GA
- NPI 1700394319
-
- Family Nurse Practitioner
- Fayetteville, GA
- NPI 1366792186
-
- Family Nurse Practitioner
- Lagrange, GA
- NPI 1275967507
-
- Family Nurse Practitioner
- Lithia Springs, GA
- NPI 1982180469
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557705600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1639440000000",
"number": "1356907695",
"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": "770-863-7200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3615 CHARLES HARDY PKWY STE 200",
"city": "DALLAS",
"state": "GA",
"postal_code": "301579472",
"telephone_number": "770-863-7200",
"fax_number": "770-505-5690"
}
],
"practiceLocations": [
{
"address_1": "1438 Dogwood Dr. SE",
"address_purpose": "LOCATION",
"city": "Conyers",
"state": "GA",
"postal_code": "30013",
"country_code": "US",
"telephone_number": "770-860-8544",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "125 Pavilion Pkwy Ste A",
"address_purpose": "LOCATION",
"city": "Fayetteville",
"state": "GA",
"postal_code": "302144098",
"country_code": "US",
"telephone_number": "770-719-0939",
"fax_number": "770-719-0940",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4221 Atlanta Hwy Ste 101",
"address_purpose": "LOCATION",
"city": "Loganville",
"state": "GA",
"postal_code": "300527316",
"country_code": "US",
"telephone_number": "704-796-3974",
"fax_number": "770-554-1167",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "210 Cobb Pkwy S Ste 100",
"address_purpose": "LOCATION",
"city": "Marietta",
"state": "GA",
"postal_code": "300606509",
"country_code": "US",
"telephone_number": "770-955-6836",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "137 Willow Ln",
"address_purpose": "LOCATION",
"city": "McDonough",
"state": "GA",
"postal_code": "302536574",
"country_code": "US",
"telephone_number": "704-830-4094",
"fax_number": "770-954-0271",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2042 W Spring St",
"address_purpose": "LOCATION",
"city": "Monroe",
"state": "GA",
"postal_code": "306553164",
"country_code": "US",
"telephone_number": "770-267-4175",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3245 Lawrenceville Suwanee Rd Ste 100",
"address_purpose": "LOCATION",
"city": "Suwanee",
"state": "GA",
"postal_code": "300246541",
"country_code": "US",
"telephone_number": "678-482-5441",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6435 Bells Ferry Rd Ste 110",
"address_purpose": "LOCATION",
"city": "Woodstock",
"state": "GA",
"postal_code": "301892317",
"country_code": "US",
"telephone_number": "770-928-0628",
"fax_number": "770-928-0646",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "MC MEDICAL LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-05-13",
"last_updated": "2021-12-14",
"certification_date": "2021-12-13",
"status": "A",
"authorized_official_last_name": "PULLURU",
"authorized_official_first_name": "SOUJANYA",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "770-863-7200"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 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.