WAYNE D KELLY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

NOT RENEWED

Business

First Name

WAYNE

Middle

Last Name

KELLY

Suffix

Business Name

WAYNE D KELLY MD

Original Issue Date

09/15/2003

Effective Date

09/15/2003

Expiration Date

07/31/2005

City

DECATUR

State

Zip

62523

County

MACON

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

04/05/2020