License holder summary

Stanley Jackson Self is a Physician licensed to practice in Indiana. The address on file for Stanley Jackson Self is Rome GA 30165. This licensed professional license is not current. The license was granted 02/20/2002 and expired on 06/30/2003.

Indiana

Professional Licensing Agency

Stanley Jackson Self
Physician
License number
01055752A
Date granted
02/20/2002
Date expires
06/30/2003
Class
Physician
Status
Expired Non-Renewable
Address
Rome GA 30165
indianalicensing.org
ID 6097617
LAST UPDATED 2024-02-09 19:39:38 UTC

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