KENN VATTATHARA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****64

License Status

ACTIVE

Business

Title

First Name

KENN

Last Name

VATTATHARA

Business Name

KENN VATTATHARA MD

Original Issue Date

12/11/2024

Effective Date

12/11/2024

Expiration Date

07/31/2026

City

JOHNSON CITY

State

Zip

37604

County

WASHINGTON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/11/2024