An official website of the State of Georgia.
How you know
Local, state, and federal government websites often end in .gov. State of Georgia government websites and email systems use “georgia.gov” or “ga.gov” at the end of the address. Before sharing sensitive or personal information, make sure you’re on an official state website.
Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia.
The following forms should be completed when applying for licensure as an Institutional Physician:
Information and Checklist
Application for Institutional License
A - Exceptional Circumstances
B - Certificate of Post Graduate Training
C - Reference Form
D - State Verification
E - Termination Form
F - Specific Power of Attorney