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 all medical staff members:

Go to Forms:

1. Print the Georgia Uniform Healthcare Practitioner Credentialing Application Form for Reappointment. Form number 1004
2. Print Clinical Privileges form(s), applicable to your expertise, if a member of the hospitals or clinics.
3. Contact System Credentialing for Part 2 .
4. Go to Documentation Required.

For physician assistants:

Go to Forms:

1. Print the Georgia Uniform Healthcare Practitioner Credentialing Application Form for Reappointment. Form number 1011
2. Print Clinical Privileges for Anesthesiology Assistants(AA)/Physician Assistants (PA). Form number 2026
3. Contact System Credentialing for the Allied Health Professional Reappointment Profile Part 2.
4. Go to Documentation Required.

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

Go to Forms:

1. Print the Georgia Uniform Healthcare Practitioner Credentialing Application Form for Reappointment. Form number 1004
2. Print Clinical Privileges Form, applicable to your expertise, if a member of the hospitals or clinic.
3. Request Allied Health Professional Reappointment Profile Part 2 from the System Credentialing Office.
4. Go to Documentation Required.