Attention All Applicants:
Please give GCMB 30 days post-submission before contacting.
PA Initial, Add/Change and Reinstatement Licensure Application Information
The following documents are required when applying for initial licensure as a Physician Assistant (including Anesthesia Assistants) in the State of Georgia:
GENERAL INFORMATION & CHECKLIST
NEW PA/AA GRADUATE LICENSURE APPLICATION INFORMATION
New Grad Information and Checklist Document
FORM A - Affidavit of Applicant
FORM B - Request for Additional Duties
FORM D - Primary Care Reference
FORM E - Anesthesia Basic Job Description
FORM F - Primary Care Basic Job Description
FORM I - Verification of Other State License
FORM K - Certificate of Education
PRIOR PA/AA LICENSEE (ANY STATE) LICENSURE APPLICATION INFORMATION
PRIOR PA/AA INFORMATION AND CHECKLIST DOCUMENT
PRIOR PA/AA LICENSURE APPLICATION FORM
FORM A - AFFIDAVIT OF APPLICANT
Citizenship
Affidavit
FORM
AC1 - ADDING AN ALTERNATE
FORM B - REQUEST FOR ADDITIONAL DUTIES
FORM C - ANESTHESIA REFERENCE FORM
FORM D - PRIMARY CARE REFERENCE FORM
FORM E - ANESTHESIA JOB DESCRIPTION
FORM F - PRIMARY CARE JOB DESCRIPTION
FORM I - VERIFICATION OF LICENSURE
FORM K - CERTIFICATE OF EDUCATION
ADD/CHANGE OF PRIMARY SUPERVISING MD
ADD/CHANGE INFORMATION AND CHECKLIST DOCUMENT
FORM B - REQUEST FOR ADDITIONAL DUTIES
FORM E - ANESTHESIA JOB DESCRIPTION
FORM F - PRIMARY CARE JOB DESCRIPTION
FORM H - SEPARATION NOTIFICATION
PHYSICIAN ASSISTANT REINSTATMENT LICENSURE APPLICATION INFORMATION
Physician Assistant Reinstatement Checklist
Physician Assistant Reinstatement Application
FORM A - Affidavit of Applicant
FORM A2 - Affidavit of Citizenship Status
FORM B - Request for Additional Duties
FORM D - Primary Care Reference
FORM E - Anesthesia Basic Job Description
FORM F - Primary Care Basic Job Description
FORM I - Verification of Other State License