Healthcare Provider Details

I. General information

NPI: 1992210579
Provider Name (Legal Business Name): GOOD DOCTOR CLINIC AND URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4759 SOUTH FWY STE A
FT WORTH TX
76115-3655
US

IV. Provider business mailing address

777 E WHEATLAND RD STE 108
DUNCANVILLE TX
75116-4918
US

V. Phone/Fax

Practice location:
  • Phone: 817-923-7374
  • Fax:
Mailing address:
  • Phone: 972-296-9930
  • Fax: 972-709-1340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. SUDATH RANNULU
Title or Position: MD
Credential: MD
Phone: 972-296-9930