An official website of the State of Georgia government.
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State government websites often end in .gov. Before sharing sensitive information, make sure you’re on a state website. Still not sure? Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia.
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The following forms are required when applying for reinstatement of your Physician license:
General Information and Checklist
License Reinstatement Application
FORM B1 - Reference
FORM C1 - Other State License Verification(s)
FORM D1 - Affidavit of Applicant
FORM D2 - Affidavit of Citizenship
FORM E1 - Malpractice Questionnaire
FORM G1 - Specific Power of Attorney