alert
:
FAKE AGENT CALLS
The Board Staff has received several phone calls from multiple licensees stating that someone is calling pretending to be an agent of the Medical Board and trying to obtain personal information. These calls are scams. Information regarding your licensure number, issue date, expiration date, and address of record is available on the Board’s website. Your NPI number is also available on the Internet. The Board would not contact you by phone to obtain your personal information. We would contact you to set up a time that you can contact us and give you a valid call back number or schedule an in person meeting. The Board is located in Atlanta, GA and all phone numbers from the Board will have Atlanta area codes. (404, 470, 678 or 770) If you receive a call like this please do not give any personal information and disconnect the call. If you need any additional information, please contact Jonathan McGehee, Director of Investigations at jmcgehee@dch.ga.gov.
Application Forms
Form A, Certificate of Postgraduate Training
Form B, Reference Form
Form D, Affidavit of Applicant
Form D2, Affidavit of Citizenship
Form E, Malpractice Questionnaire
Form G, Specific Power of Attorney
Form H, Request for Temporary License
(NOTE: Do not use Form H unless your Applications Specialist has told you are eligible)
License History Addendum
Other Physician Application Pages