Please return all applications to:

Emory Healthcare
Medical Staff Services & System Credentialing
101 West Ponce de Leon Avenue, Suite 300
Decatur, Georgia 30030

Office: (404) 778-5034
Fax:     (404) 778-4819  

For community physicians, (Non-Emory School of Medicine Faculty) applying for staff membership at:

Emory Crawford Long Hospital
Emory Johns Creek Hospital
Wesley Woods Geriatric Hospital
Wesley Woods Long-Term Hospital
Wesley Woods Long-Term Care/Budd-Terrace

Go to Forms:

1. Print Part I of the Georgia Uniform Healthcare Practitioner Credentialing Application Form. Form number 1002
2. Print Part II of the Emory Healthcare Initial Application. Form number 1003
3. Print the Clinical Privileges Form(s), applicable to your expertise.
4. Print Work History Form. Form number 1013
5. Go to Documentation Required.

For Emory School of Medicine Faculty, the provider enrollment coordinator will notify you when to obtain the application package from this website.  Our department must receive a Chair Request providing authorization to credential you.

Once you have received notification:

Go to Forms.

1. Print Part I of the Georgia Uniform Healthcare Practitioner Credentialing Application Form. Form number 1002
2. Print Part II of the Emory Healthcare Initial Application. Form number 1003
3. Print the Clinical Privileges form(s) applicable to your expertise, if applying for membership at the hospitals or  clinic.
4. Print Work History Form. Form number 1013
5. Go to Documentation Required.

For all physician assistants:

Go to Forms:

1. Print Part 1 of the Georgia Uniform Allied Healthcare Professional Credentialing Application form. Form number 1005
2. Print the Emory Healthcare Allied Health Professional Initial Application Part 2.  Form number 1006
3. Print Clinical Performance Evaluation. Form number 1007
4. Print Clinical Privileges for Anesthesiology Assistants(AA)/Physician Assistants (PA). Form number 2026
5. Go to Documentation Required.

For all scientific, podiatric and dental staff, and allied health professionals other than physician assistants.

Go to Forms:

1. Print Part 1 of the Georgia Uniform Allied Healthcare Professional Credentialing Application Form. Form number 1005
2. Print the Emory Healthcare Allied Health Professional Initial Application Part 2.  Form number 1006
3. Print Clinical Privileges Form, applicable to your expertise, if applying for membership at the hospitals or clinic.
4. Discard any forms not applicable to your profession.
5. Go to Documentation Required.