Physician Request Application Process

Thank you for your interest in Piedmont Healthcare.  We recognize that the hospital application process can be a time consuming process.  To help alleviate potential delays, Piedmont Healthcare utilizes a Central Verification Office (CVO) to handle all physician and allied health applications for appointment to any Piedmont facility.  This significantly reduces the amount of time required to process an application by implementing the following key changes:

  • Only one application will be required whether applying for privileges at one or more facilities 
  • Several processes will be automated internally, reducing the amount of time a provider spends completing the required documents 
  • Credentials are verified centrally instead of by each facility

By requesting an application from Piedmont Healthcare you as a physician, dentist, oral surgeon, or podiatrist certify that you meet the following minimum requirements:

  • have a current, unrestricted license to practice in Georgia and have never had a license to practice revoked, suspended, or limited by any state licensing agency;
  • where applicable to their practice, have a current, unrestricted DEA registration;
  • be located (office and residence) close enough to fulfill their Medical Staff responsibilities and to provide timely and continuous care for their patients in the Hospital;
  • have current, valid professional liability insurance coverage in a form and in amounts satisfactory to the Hospital;
  • have not been convicted of, or entered a plea of guilty or no contest to,  Medicare, Medicaid, or other federal or state governmental or private third-party payer fraud or program abuse, nor have been required to pay civil monetary penalties for the same;
  • have not been, and are not currently, excluded, precluded, or debarred from participation in Medicare, Medicaid, or other federal or state governmental health care program;
  • have not had Medical Staff appointment or clinical privileges denied, revoked, or terminated by any healthcare facility or health plan for reasons related to clinical competence or professional conduct;
  • have not resigned Medical Staff appointment or relinquished privileges during a Medical Staff investigation or in exchange for not conducting such an investigation;
  • have not been convicted of, or entered a plea of guilty or no contest, to any felony; or to any misdemeanor relating to controlled substances, illegal drugs, insurance or health care fraud or abuse, child abuse, elder abuse, or violence;
  • demonstrate recent clinical activity in their primary area of practice during the last two years;
  • meet any current or future eligibility requirements that are applicable to the clinical privileges being sought;
  • if applying for privileges in an area that is covered by an exclusive contract, meet the specific requirements set forth in that contract;
  • document compliance with all applicable training and/or educational protocols that may be adopted by the MEC and/or required by the System Board, including, but not limited to, those involving electronic medical records or patient safety;
  • have successfully completed:
    • a residency or fellowship training program approved by the Accreditation Council for Graduate Medical Education (“ACGME”) or the American Osteopathic Association (“AOA”) in the specialty in which the applicant seeks clinical privileges; 
    • a dental or an oral and maxillofacial surgery training program accredited by the Commission on Dental Accreditation of the American Dental Association (“ADA”); 
    • or a podiatric surgical residency program accredited by the Council on Podiatric Medical Education of the American Podiatric Medical Association; 
  • be certified in their primary area of practice at the Hospital by the appropriate specialty/subspecialty board of the American Board of Medical Specialties (“ABMS”), the AOA, the American Board of Oral and Maxillofacial Surgery, the ADA, or the American Board of Podiatric Surgery, as applicable. Those applicants who are not board certified at the time of application but who have completed their residency or fellowship training within the last five years shall be eligible for Medical Staff appointment.  

If the applicant does not meet the items on this list they should contact the Medical Staff Office for the primary facility to which they are applying (contact information below) before requesting an application to discuss any special circumstances.

If the above requirements are met, you may fill out our request for application questionnaire.  Please note that you will be required to provide a credit / debit card at the point of request and all appropriate application fees and deposits must be paid before an application will be accepted and / or processed.  These fees will not be refunded for any reason.  

If you would like to learn more about a particular Piedmont Healthcare facility, or have any questions about the application process, please contact Kenya Jones at