Physician License Requirements

Submit a Physician License Online Application

• Submission Guidelines: Use the Board’s online portal for all applications. Ensure all questions are answered fully and truthfully. For any ‘Yes’ responses, provide a detailed account and upload supporting documents (e.g., court records, board actions) through the portal.

• Click HERE to download the step-by-step walkthrough for assistance with submitting an online application

   

Application Fee Information

Payment Instructions: Pay fees through the online portal using a credit/debit card during application submission. Note: Checks and money orders are not accepted. The fee includes two separate charges: the Board’s fee and a 3.15% card processing fee retained by the processor.

Specific Power of Attorney Form

• Initial Submission: Upload documents directly in the online account during application submission.

• Post Submission: If the application is already submitted, email documents to [email protected] with the applicant’s full name in the subject line.

• Optional Authorization Form:

  • Submit if you authorize a third party (e.g., hospitals, employers, recruiters) to assist with your application.

  • Required for the Board to share application details, as applications are confidential by State law.

• Email Attachments:

  • Attach this form in emails from credentialing agents/agencies.

  • Ensure the notary seal is clear on the scanned PDF.

• Third-Party Details:

  • Include the third party’s contact information.

  • The form must be signed by the applicant and notarized.

• Notarization Compliance:

  • The Board accepts notary stamps adhering to the origin jurisdiction’s laws.

  • For instance, Georgia mandates in-person notarization, but remote notarizations from states permitting it, like Virginia, are valid.

     

Military Discharge Paperwork (if applicable)

• For New Applications: Upload the document during online application.

• For Submitted Applications: Email to [email protected] with the applicant’s name as the subject.

• Military Applicants Only: Provide a copy of the Report of Separation from Active Duty, not the discharge certificate.

   

CV / Resume

• For New Applications: Upload documents during the online application process.

• For Existing Applications: Email to [email protected] with the applicant’s name in the subject line.

• Details Required: Provide a chronological record of clinical practice, education, employment, and clarify any gaps. Include the date(s) of your last clinical practice.

   

Affidavit of Applicant

• Online Submission: Upload the document with your application.

• Email Submission: If already applied, email to [email protected] with the applicant’s name in the subject.

• Form Requirements:

  • Complete all sections of the form.

  • Attach a current, color passport photo. Avoid using photos from non-official sources.

  • Ensure the photo and notary seal are clear in the scanned PDF.

  • The applicant and notary’s signature dates must be identical.

  • Do not alter the form with whiteouts or strikeouts.

  • The form must be signed and notarized.

• Notary Compliance:

  • Acceptable notary stamps must adhere to the laws of their origin. Georgia requires in-person notarization, while remote notarizations are valid from states where permitted.

     

Citizenship Affidavit

• Online: Upload with your application.

• Email: Send to [email protected] post-submission with the applicant’s name in the subject.

• Document Requirements:

  • Signatures of the applicant and notary must coincide.

  • No alterations (whiteouts/strikeouts) allowed.

  • Must be signed, notarized, and the notary seal clear on the PDF.

• Notary Acceptance:

  • Notary stamps must follow the laws of their origin. Georgia mandates in-person notarization, but remote notarizations are recognized if legal in the originating state.

     

Citizenship Verifiable Documents List

• Online: Upload documents with your application.

• Email: If already applied, email to [email protected] with the applicant’s name in the subject.

• For U.S. Citizens: Provide a clear copy of your Driver’s License or Passport.

• For Non-U.S. Citizens:

  • Submit clear copies of alien status documents (e.g., Permanent Resident Card, SEVIS document).

  • Ensure legibility of Alien Number, Card Number, Document Expiration Date, and SEVIS ID Number for SAVE program verification.

  • More info:  https://www.fsmb.org/fcvs

     

Certification of Postgraduate Training Form

• Submission: Documents must be sent from the GME program to [email protected] with “residency verification” and the applicant’s name in the subject.

• FCVS Profile: May be included in the FCVS profile. Confirm with Board after FCVS notification. More info:  https://www.fsmb.org/fcvs

• Seals/Stamps: Must be clear.

• Training Duration:

  • Board-Approved Schools: Minimum one year of ACGME training.

  • Non-Approved Schools: Three years of ACGME training required. Documentation must verify completion.

  • Policies: Refer to the Board’s policy for medical schools and international graduates: https://medicalboard.georgia.gov/international-medical-graduate-policy-022010

     

Official Medical Licensing Examination Score Transcript Information

• Direct Source: Must be emailed by the examination authority to [email protected] (subject: applicant’s name). This document is NOT accepted from the applicant or credentialing agent/agency.

• FCVS Profile: Can be part of your FCVS profile. Check with the Board post-FCVS notification. More info:https://www.fsmb.org/fcvs

   

Reference Form

• Method: Must be emailed from the physician’s business address to [email protected] with “reference form” and the applicant’s name in the subject.

• Requirements:

  • Initial Licensure: Three signed and dated references from physicians familiar with your practice for over six months.

  • Reinstatement: Two references are required.

  • Validity: Forms are valid for six months.

     

National Practitioner Data Bank Self-Query Information (NPDB)

• NPDB Self-Query Submission Guide:

  • Submission: Upload with application or email to [email protected] (subject: applicant’s name).

  • FCVS Profile: Include as part of FCVS profile. Confirm with Board after FCVS notification. More info: https://www.fsmb.org/fcvs

  • Mandatory: Required for applicants with prior licensure to track disciplinary actions and malpractice payments.

  • Self-Query: Perform a self-query if previously licensed. Upload the response with your application.

  • Assistance:

    • How to order a self-query: https://www.npdb.hrsa.gov/pract/selfQueryVideo.jsp

    • Interpreting results: https://www.npdb.hrsa.gov/resources/selfQueryResponseGuide.jsp

Note: If an applicant has never held a full medical license before (in any jurisdiction), the NPDB self-query is NOT required.

Official License Verification(s) Information

• License Verification Submission Overview:

  • Direct Submission: Must be sent from the licensing board to [email protected] (subject: applicant’s name).

  • Scope: Required for all medical licenses held in any U.S. state, territory, or Canadian province.

  • VeriDoc Participation: Verifications can be provided via VeriDoc. More info: www.veridoc.org

  • Kentucky Licenses: GCMB accepts verifications directly from the applicant if issued by the Kentucky Medical Board.

Note: No verification needed if you’ve never held a medical license

Note: Birth Certificates and Driver’s Licenses are not suitable proofs of citizenship status. Incomplete or illegible submissions may delay application processing.

Malpractice Questionnaire Form

• Malpractice Questionnaire & Documentation Submission:

  • Submit Online: Upload with application or email to [email protected] (subject: applicant’s name).

  • For All Applicants: Complete all sections; mark “None” if no malpractice cases.

  • If Named in a Case: Provide full case details.

  • Signature Required: Sign and date the form; notarization not needed.

  • Multiple Cases: Use a separate form for each case.

• Malpractice Documentation (if applicable):

  • When Required: Only if named in a malpractice case.

  • Document Compilation: Assemble all case documents into one file per case, including:

    • Malpractice Questionnaire Form

    • Personal Narrative

    • Plaintiff’s Complaint

    • Legal Dispositions (e.g., Summary Judgment, Dismissal Order)

       

Continuing Medical Education (CMEs)(if applicable)

• How to Submit: Upload with your application or email to [email protected] with your name in the subject line

• Applicant Type: Only for reinstatement applicants.

• File Format: Scan all CME documents into one file; do not upload individually.

• Hour Limit: Maximum of 50 hours; you’ll be notified if more is needed.

• Copy Quality: Provide clear 8.5 x 11 copies only.

• Information Required: Include provider name, program name, hours/CEUs, completion date, and proof of A.M.A. or A.O.A. Category 1 credit.

• See Here for More Information

   

Official Medical School Transcript

• Submission Source: Must be sent directly from the medical school to [email protected] (applicant’s name in subject).

• FCVS Profile: Can be part of the FCVS profile. Confirm with Board staff after FCVS release.

• Seals/Stamps: Must be clear and recognizable.

• Non-English Transcripts: Include a certified English translation.

   

ECFMG Certification Information (for foreign medical schools)

• Direct Upload: Include with application or email to [email protected] (subject: applicant’s name).

• FCVS Profile: May be part of the FCVS profile sent by FSMB. Verify with Board after FCVS notification.