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Georgia Composite Medical Board Use Only Temporary File Number Date Issued License Number Physician Assistant Application ADD OR CHANGE SUPERVISING PHYSICIAN All fees are nonrefundable and subject to change. Submit this form with your completed application. Are you a Georgia state employee If yes you are fee exempt. If yes enter the Facility Name Utilization of Physician Assistant Provide physician information for the physician requesting utilization of a physician assistant. 2010 PHYSICIAN...
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