MARY K RANDOLPH Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036121726

License Status

NOT RENEWED

Business

First Name

MARY

Middle

Last Name

RANDOLPH

Business Name

MARY K RANDOLPH

Original Issue Date

08/12/2008

Effective Date

04/24/2014

Expiration Date

07/31/2017

City

SULLIVAN

State

Zip

61951

County

MOULTRIE

Ever Disciplined

LastModifiedDate

11/01/2017