Provider Demographics
NPI:1992210579
Name:GOOD DOCTOR CLINIC AND URGENT CARE PLLC
Entity Type:Organization
Organization Name:GOOD DOCTOR CLINIC AND URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDATH
Authorized Official - Middle Name:
Authorized Official - Last Name:RANNULU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-296-9930
Mailing Address - Street 1:777 E WHEATLAND RD STE 108
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4918
Mailing Address - Country:US
Mailing Address - Phone:972-296-9930
Mailing Address - Fax:972-709-1340
Practice Address - Street 1:4759 SOUTH FWY STE A
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-3655
Practice Address - Country:US
Practice Address - Phone:817-923-7374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty