MARY K RANDOLPH Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****37

License Status

NOT RENEWED

Business

First Name

MARY

Middle

Last Name

RANDOLPH

Business Name

MARY K RANDOLPH

Original Issue Date

08/19/2008

Effective Date

04/24/2014

Expiration Date

07/31/2017

City

DECATUR

State

Zip

62526

County

MACON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017