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

New Grad License Application

FORM A - Affidavit of Applicant

Citizenship Affidavit

FORM B - Request for Additional Duties

FORM C - Anesthesia Reference

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

PA/AA Utilization Form

 

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 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

PA/AA Utilization Form

 

ADD/CHANGE OF PRIMARY SUPERVISING MD

ADD/CHANGE INFORMATION AND CHECKLIST DOCUMENT

ADD/CHANGE APPLICATION

   FORM AC1 - ADDING AN ALTERNATE

  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 C - Anesthesia Reference

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

PA/AA Utilization Form