MEREDITH WALL WAGNER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

ACTIVE

Business

Title

First Name

MEREDITH

Middle

WALL

Last Name

WAGNER

Business Name

MEREDITH WALL WAGNER MD

Original Issue Date

08/14/2023

Effective Date

08/14/2023

Expiration Date

07/31/2026

City

DECATUR

State

Zip

62526

County

MACON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/14/2023