Licensing Specialist - A to D Katonya Reynolds
Physician
For questions about renewing your active Physician license, contact us at [email protected] or at 404-656-3913.
Initial Physician Licensure
When you apply, your application and the additional documents will be needed to complete your file. In order to ensure a smooth process send these documents to the Board in a single envelope (
instructions
).
Once a licensed professional and DEA holder in Georgia, you will be required to register with the Georgia PDMP
Checklist for Initial Physician
Below are the application and forms to complete and should be included in your Initial Physician packet:
Initial
Physician License Application
.
or Online Application PDF copy (if you applied online). If you are applying for a Telehealth or Administrative license, you must complete the requirements for an unlimited Georgia medical license.
FORM
A- Certificate of Postgraduate Training
FORM
B- Reference Form
FORM
D- Affidavit of Applicant
FORM
D2- Affidavit for Medical Board License
FORM
E- Mandatory Malpractice Questionnaire
FORM
G- Specific Power of Attorney
Links to other Physician applications:
Reinstatement
of Georgia Physician License
Institutional Physician License
Educational Training Certificate
Other Physician Forms and Information
Physician Profile Information and Forms
Decorative
Wall License Certificate (Physician)
Duplicate
License Card (Wallet Card)
For questions about your pending application for Physician licensure (Initial or Reinstatement), if your last name begins with the alphabetic character:
Licensing Specialist - A to D Katonya Reynolds
Licensing Specialist - E to K Dwana Robinson
Licensing Specialist - L to P, Philip Hamilton
Licensing Specialist- Q to Z Deborah Bruce