CHARELLE OCTAVIA SMITH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

ACTIVE

Business

Title

First Name

CHARELLE

Middle

OCTAVIA

Last Name

SMITH

Business Name

CHARELLE OCTAVIA SMITH MD

Original Issue Date

07/23/2020

Effective Date

04/15/2023

Expiration Date

07/31/2026

City

CARBONDALE

State

Zip

62901

County

JACKSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/15/2023