STACEY RAE BLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036144831

License Status

NOT RENEWED

Business

Title

First Name

STACEY

Middle

RAE

Last Name

BLACK

Business Name

STACEY RAE BLACK MD

Original Issue Date

12/20/2017

Effective Date

12/20/2017

Expiration Date

09/30/2020

City

RINGGOLD

State

Zip

30736

Ever Disciplined

LastModifiedDate

01/14/2021