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 Assistant) in the State of Georgia:

GENERAL INFORMATION & CHECKLIST

NEW AA/PA GRADUATE LICENSURE APPLICATION INFORMATION

Download this pdf file. New Grad Information and Checklist Document

Download this pdf file. New Grad License Application

Download this pdf file. FORM A - Affidavit of Applicant

Download this pdf file. FORM A2 - Affidavit of Citizenship Status

Download this pdf file. FORM B - Request for Additional Duties

Download this pdf file. FORM C - Anesthesia Reference

Download this pdf file. FORM D - Primary Care Reference

Download this pdf file. FORM E - Anesthesia Basic Job Description

Download this pdf file. FORM F - Primary Care Basic Job Description

Download this pdf file. FORM I - Verification of Other State License

Download this pdf file. FORM K - Certificate of Education

 

PRIOR AA/PA LICENSEE (ANY STATE) LICENSURE APPLICATION INFORMATION

Download this pdf file. PRIOR PA/AA INFORMATION AND CHECKLIST DOCUMENT

Download this pdf file. PRIOR PA/AA LICENSURE APPLICATION FORM

Download this pdf file.   FORM A - AFFIDAVIT OF APPLICANT

Download this pdf file.   FORM A2 - AFFIDAVIT OF CITIZENSHIP STATUS

Download this pdf file.   FORM B - REQUEST FOR ADDITIONAL DUTIES

Download this pdf file.   FORM C - ANESTHESIA REFERENCE FORM

Download this pdf file.   FORM D - PRIMARY CARE REFERENCE FORM

Download this pdf file.   FORM E - ANESTHESIA JOB DESCRIPTION

Download this pdf file.   FORM F - PRIMARY CARE JOB DESCRIPTION

Download this pdf file.   FORM I - VERIFICATION OF LICENSURE

Download this pdf file.   FORM K - CERTIFICATE OF EDUCATION

 

ADD/CHANGE OF PRIMARY SUPERVISING MD

Download this pdf file. ADD/CHANGE INFORMATION AND CHECKLIST DOCUMENT

Download this pdf file. ADD/CHANGE APPLICATION

Download this pdf file.   Download this pdf file. FORM AC1 - ADDING AN ALTERNATE

Download this pdf file.   FORM B - REQUEST FOR ADDITIONAL DUTIES

Download this pdf file.   FORM E - ANESTHESIA JOB DESCRIPTION

Download this pdf file.   FORM F - PRIMARY CARE JOB DESCRIPTION

Download this pdf file. FORM H - SEPARATION NOTIFICATION

 

PHYSICIAN ASSISTANT REINSTATMENT LICENSURE APPLICATION INFORMATION

Download this pdf file. Physician Assistant Reinstatement Checklist       

Download this pdf file. Physician Assistant Reinstatement Application        

Download this pdf file. FORM A - Affidavit of Applicant

Download this pdf file. FORM A2 - Affidavit of Citizenship Status

Download this pdf file. FORM B - Request for Additional Duties

Download this pdf file. FORM C - Anesthesia Reference

Download this pdf file. FORM D - Primary Care Reference

Download this pdf file. FORM E - Anesthesia Basic Job Description

Download this pdf file. FORM F - Primary Care Basic Job Description

Download this pdf file. FORM I - Verification of Other State License