| NPI | 1174930150 |
|---|---|
| Other Name | WALMART CARE CLINIC 10-0658 |
| Entity Type | Organization |
| Authorized Contact | SOUJANYA PULLURU President 706-728-3246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2021-12-07 |