MC Medical LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MC MEDICAL LLC

Doing business as

Walmart Health

Practice address

1735 S Highway 27
Carrollton, GA 30117-8941

Phone

(770) 809-7002

Fax

(770) 838-0659

NPI assigned

Jul 21, 2014

Last updated

Nov 23, 2022By the provider in NPPES

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

Owner

Phone

(479) 204-1258

Specialties & licenses 2

Addresses

Other names 1

• Walmart Health Doing business as

Locations

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

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669161600000",
    "number": "1447667696",
    "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": "1735 S HIGHWAY 27",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301178941",
            "telephone_number": "770-809-7002",
            "fax_number": "770-838-0659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MC MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-21",
        "last_updated": "2022-11-23",
        "certification_date": "2022-11-23",
        "status": "A",
        "authorized_official_last_name": "PULLURU",
        "authorized_official_first_name": "SOUJANYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-204-1258"
    },
    "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 Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nilsey M Matos
• Matrix Rehabilitation-Georgia Inc (Physiotherapy Associates)
• Andrea Marie Maxwell
• Daniel Lee Maxwell
• Mary E Maxwell, PA
• Alicia McCall, OT
• Debra A McCollister, RDH
• Prentice Michael McCullough, M.D.
• Latiana Corsheka McDaniel
• Jennifer W. McDonald, CNM, NP-C

• General Practice Physician in Carrollton, GA
• Providers in Carrollton, 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 Nov 23, 2022; 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.