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Georgia Composite Medical Board
Minutes of the May 6, 2021 Meeting
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The Georgia Composite Medical Board (GCMB) held its regular meeting on May 6, 2021 via
teleconference at 2 Peachtree Street, Atlanta, GA 30303, to consider Medical Board matters.
Board members on the call:
John S. Antalis, MD
William Bostock, DO
Gretchen Collins, MD
Debi Dalton, MD
E. Dan DeLoach, MD
Charmaine Faucher, PA (ex-officio)
Austin Flint, MD
Judy Gardner, FASHP, Consumer Member
Alexander Gross, MD
Shawn Hanley, Consumer Member
Thomas Harbin, MD, Vice Chair
J. Jeffery Marshall, MD
Andrew Reisman, MD
David Retterbush, MD
Barby Simmons, DO, Chair
Board member absent: Matthew Norman, MD
Management staff present: LaSharn Hughes, MBA, Executive Director
Phyllis White, Executive Assistant
Jonathan McGehee, Director of Investigations
Latisha Bias, Enforcement Supervisor
Legal staff on the call: Max Changus, JD, Assistant Attorney General
Betsy Cohen, JD, Assistant Attorney General
CALL TO ORDER Dr. Simmons called the meeting of the Georgia Composite Medical Board to order at 7:30 a.m.
AGENDA Dr. Marshall made a motion, seconded by Dr. Reisman to approve the agenda of the May 6, 2021
meeting. The motion carried unanimously.
MINUTES Dr. Retterbush made a motion, seconded by Dr. Harbin to approve the minutes of the April 1,
2021 meeting. The motion carried unanimously.
EXECUTIVE DIRECTOR’S REPORT Ms. Hughes, Executive Director, presented the following report:
Mr. McGehee has made progress in updating the Board’s website from the suggestions from the Audit
and Ms. Faucher, Chairman of the Public Outreach Committee.
Ms. Hughes updated the Board on the difficulties in hiring staff, since the pandemic. She is hopeful to
be fully staffed soon.
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Georgia Composite Medical Board
Minutes of the May 6, 2021 Meeting
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Request from Stephanie Saladino, whether the Board has interpreted or has issued any guidance
regarding the definition of an “FDA-approved treatment” under the Georgia Right to Try Act (Ga. Code
31-52-4). Specifically, we want to understand whether the term “FDA-approved treatment” includes
surgical procedures as well as therapeutics. The Board referred Ms. Saladino to Department of
Community Health for a response, since this is not in the Board’s laws or rules.
Request from Christy Hembree searching for information on Radiology Practitioner Assistants (RPAs).
We need information regarding GA law in the hospital setting (IP/OP/ER). The Board referred the
request to the Rules Committee.
Request from the Wisconsin Board of Medicine, which is currently undertaking a review of licensees
(physicians, physician assistants, etc.) who are practicing what is being referred to as “Functional
Medicine” (including but not limited to Platelet Rich Plasma injections, and Bio-Identical Hormone
Replacement therapy). The Board is interested in the position, if any, of other State Medical Boards,
and relevant agencies such as FSMB with regard to this type of practice and whether it is within the
scope of acceptable practice of medicine and surgery and within the standard of care of such practice.
The Board has not had any issues with this practice.
RULES HEARING Motion Dr. Harbin, seconded Dr. Marshall and motion carried to adopt the following rules:
Rule 360-2-.05 Renewal Applications
Rule 360-5-.02 “Qualifications for Physician Assistant License”
Rule 360-5-.03 “Application for Physician Utilization of a Physician Assistant”
Rule 360-5-.04 “General Job Description”
Rule 360-5-.05 “Limitations on Physician Practice”
Rule 360-5-.06 “Renewal of Physician Assistant License”
Rule 360-5-.11 “Standards for Physician Assistant Practice”
Rule 360-5-.12 “Guidelines concerning Prescriptive Authority”
Rule 360-32-.01 “Definitions”
Rule 360-32-.02 “Requirements for Nurse Protocol Agreements Pursuant to Code Section 43-34-25.
REVIEW HEARING Richard Blake, PA, requested a review hearing. Max Changus, Assistant Attorney General, appeared on
behalf of the Board. Mr. Blake was represented by Attorney Matt Bass. The Board members asked
questions, then Mr. Blake and his attorney responded. The Board voted to go into Executive Session to
deliberate. Dr. Simmons declared the meeting in Open Session. Dr. Retterbush made a motion,
seconded by Dr. Harbin, to uphold the Initial Decision of the Administrative Law Judge. Dr. Reisman
and Dr. DeLoach both abstained.
CLOSED SESSION Dr. DeLoach motioned seconded by Dr. Dalton to go into closed session to discuss applications,
investigations and disciplinary matters. The motion carried unanimously.
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Georgia Composite Medical Board
Minutes of the May 6, 2021 Meeting
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OPEN SESSION Dr. Simmons declared open session.
ATTORNEY GENERAL (AG) Max Changus, Assistant Attorney General presented the AG Status Report. Dr. Marshall submitted a
motion, seconded by Dr. DeLoach and motion carried to accept the report as information and approved
the following Board Orders:
ORDERS FOR APPROVAL:
John Seal, Cease and Desist Order
Michael Bowen, RCP
David Toone, Acupuncturist
Natalie Jackson, SLP
Ovez Sitifiawala, PA
Tracy Lynn Deltac, ALP
Andrea Chancey, PA
John Farrior, PA
Angela L. McDowell, DO
Myla Bennett, MD
PHYSICIAN LICENSURE COMMITTEE Dr. Retterbush presented the Licensure Committee Report:
The Board took the following actions:
Approve Petition(s) to Waive Rules
Brazzale, Katherine – Rule 360-2 - .02
Midence, Carlos – Rule 360-2-.01 (f) ii
Approve Petition(s) to Waive Rules Pending
Chintala, Sreedhar – Rule 360-2- .02: USMLE Score Transcript
Deny Petition(s)to Waive Rule(s)
Kelleigh, Courtney – Rule 360-2- .01 (e)(i). Must take an examination.
Questions/Requests
Deny request from Shohab Virk for Board Sponsorship to Retake the USMLE Step 1.
Deny request from Neel Patel for Board to accept training of AACMFS instead of ACGME.
Approve License Applications:
Initial
Cornish, Eboni
Garg, Ruchi
Goldberg, Michael
Hill, Domonic
Karagas, Michael
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Minutes of the May 6, 2021 Meeting
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Kokocki, Stanley
Lee, David
Maher, James
Maxwell, Robert
McKinney, Terry
Rageh, Abdouirahman
Rehman, Faiz
Robinson, Julie
Shields, Jessica
Smith, Nathan
Sood, Rajiv
Varanasi, Ballavital
Webber, Matthew
Welsch, Michael
Wroblicky, Peter
Residency Training Permit Pending
Fazal, Rahim – ECFMG certification certificate
Reinstatement
Lettsom, Lyndell
Novince, Ryan
Rhodes, Vicki
Administrator in Medicine
Pearce, Melissa (AIM)
Institutional
Da Costa, Adilson
Approve Residency Training Permit Renewals
Schild, Chris
Ibrahim, Ghaith
Adams, Sarah
Kham, Ambreen
Mudaliar, Prathik
Approve License Application Pending
EW
Administrative License, Clinical Skills Examination or Allow to withdraw or Deny
RB
HW
JR
Table
AH – for additional information.
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Georgia Composite Medical Board
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Deny
KC (Institutional)
ET - Deny based on permanent suspension of NJ medical license.
ADMINISTRATIVELY APPROVED
Name Degree
Abdelkarim, Riad Z MD
Adair, Dionne MD
Addo, Basilio N MD
Addo, Jennifer E MD
Adeniyi, Abdul-Razaq MD
Adu-Gyamfi, Kwabena O MD
Agasarkisian, Lousine MD
Agboola, Nuratullahi O MD
Agdassi, Haleh MD
Ahmad, Mazna T MD
Akbar, Syed A MD
Alderson, Chevon M MD
Alex, Kezia MD
Alic, Linda L MD
Almasi, Patris MD
Alonso, Zin H MD
Antzoulatos, Eleni MD
Appleby, Megan L MD
Appleton, Nicolas C MD
Asangmbeng, Nformbuh MD
Ashimolowo, Toluwalase MD
Asuzu, Christopher C MD
Athreya, Hariharan MD
Avila Hernandez, Adrian N MD
Azam, Mohammad U MD
Aziz, Madiha MD
Bandhakavi, Vijay MD
Barnett, Robert K MD
Bauer, Joseph M DO
Bellam, Clayton P DO
Bender, Gregory MD
Bertino, Frederic J MD
Beus, Jonathan M MD
Bodine, Charles MD
Boghani, Zain MD
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Bohannon, Katherine E DO
Boissonneault, Adam R MD
Bontrager, Travis D MD
Booy, David N MD
Bordlee, John MD
Bowles, Richard J MD
Brady, Evan K MD
Brasfield, Kirasten G MD
Brazzale, Katherine L MD
Brittsan, Caylie P MD
Brock, Paul B, Jr MD
Brown, Jacqueline T MD
Bsirini, Caroline MD
BUCH, KUNAL MD
Buono, Alyssa B MD
Burch, Joseph S MD
Burrer, Phillip F MD
Butler, Shauna M MD
Cail, Austin J MD
Caldwell-Sachar, Haven L DO
Callahan, Daryl J DO
Caro, Christina G MD
Carswell, Lindsey DO
Carter, Ann-Gelle S MD
Cavallo, Gina M MD
Cawley, Clinton M MD
Chan, Christopher DO
Chand, Rohin DO
Chaudhary, Dhruv R MD
Chintala, Sreedhar MD
Chopra, Swati MD
Chow, Kevin L MD
Christenbury, Mary M MD
Christenson, Vernon L MD
Claudio-Gonzalez, Ivan L MD
Clavijo, Alex MD
Close, Brian M MD
Cochi, Shea E MD
Cole, Adam J MD
Conti, Paul A MD
Cook, Schuyler DO
Cooper, Joel R MD
Cornish, Eboni MD
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Minutes of the May 6, 2021 Meeting
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Cox, Ralph F, Jr MD
Cranford, Michael C DO
Creel, Rebecca G MD
Crismon, Heidi MD
Cullison, Timothy A MD
Cummings-Johnson, Paige M DO
Daniel, Alexander E MD
Daskalakis, Demertre C MD
Davidson, Sean R MD
Dawit, Sara MD
Day, Matthew J DO
De Leon Benedetti, Andres M MD
Deal, Joshua MD
Dean-Colomb, Windy MD
DeBeaux, Austin C MD
DeCesare, Gary MD
Defore, Salome E MD
Delamota, Jessica I DO
Desai, Shivang R MD
DeSouza, Stephen M MD
Dickstein, Ross MD
DiGiandomenico, Stefanie M MD
Dimitrijevic, Oliver MD
Do, Thanh M DO
Doane, TristanT MD
Donatien, Jose MD
Doshi, Ricky MD
Drylewicz, Monica R MD
Durkin, Sean J MD
Earl, Victoria C MD
Egbo, Obinna P MD
Elfar, Mohamed MD
Erlich, Victor M MD
Essa, Amr MD
Evans, Austin J MD
Evans, Casey B MD
Evans, Whitney MD
Farooqui, Amreen MD
Farwell, Charles D MD
Feldpausch, Nora I MD
Ferenczy, Joshua MD
Floyd, Matthew T MD
Fortner, Corwyn MD
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Franckowiak, Emily MD
Fung, Russell K MD
Fussner, Steven L MD
Gage, Harold A MD
Gagnon, Marie-Helene MD
Galper, Merav MD
Galvan, Erickson R MD
Garden, Benjamin C MD
Garg, Ruchi MD
Geneve, Nikerson DO
Ghate, Deepta A MD
Gillen, Matthew C MD
Gilliam, Lynda MD
Glaser, Charles I MD
Gleason, Bonnie T MD
Gnanajothy, Rosana MD
Goldberg, Michael T MD
Goldstein, Matthew DO
Gonzalez-Beicos, Aldo MD
Gorle, Swathi MD
Graham, Tiffany M MD
Grant, Daniel N MD
Gray, Joseph M MD
Grijalva, Steven D MD
Grimes, Joanna M MD
Guerrero-Calderon, Juan D MD
Habib, Adnan N MD
Hajighasemi-Ossareh, Mohammed MD
Hall, Charles MD
Hall, Jennifer B MD
Hallett, Thao-Phuong C MD
Hampton, Stephanie F MD
Harper, Benjamin T MD
Harper, Christopher W, Jr MD
Harris, Lisa K MD
Harris, Nicholas MD
Hatoum, Hadi MD
Hekman, Katherine E MD
Hemphill-Bryant, Zuri D MD
Hill, Domonic J MD
Hira, Jasmina DO
Hito, Rania MD
Holder, Angela J MD
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Hutchinson, Tanisha R MD
Ibidapo, Kaylah MD
Ibrahim, Saman MD
Illg, Zachary N DO
Iloh, Florence N MD
Irizarry, Rachel MD
Isaak, Kevin A MD
Isnassuos, Mena MD
Jain, Tarun MD
Jamshidi, Raehannah J MD
Jeffries, Howard E MD
Jeter, Robert, II MD
Joe, Deanna S MD
Jones, Margaret R MD
Jonsson, Amalia A MD
Jotwani, Anil MD
Jung, Andrew D MD
Kadiwar, Amisha A MD
Kafrouni, Abdallah MD
Kain, Conor MD
Kane, Dennis R MD
Kang, Julia Y MD
Kang, Myong J MD
Kanter, Jenna R MD
Kanugula, Ashok Kumar MD
Kapadia, Jeet P MD
Kapoor, Madhavi P MD
Kapp, Meghan MD
Kashlan, Khaled N MD
Kawar, Yaser F MD
Khan, Fahad Ullah MD
Khan, Tuba MD
Kieffer, Theodore MD
Kim, Beomjune B MD
Kim, Eric S MD
Klaas, James P MD
Kocharyan, Hakob MD
Kokocki, Stanley P MD
Kostanjevec, Juilett R DO
Kucera, Walter B MD
Kuhn, Karin MD
Kunkel, Katherine J MD
Kwon, Elena H DO
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Lamousin, James C MD
Large, Thomas M MD
Lassinger, Brett C MD
Lawson, Eric C MD
Leahman, Courtenay MD
Lee, David MD
Lee, Kameryn MD
Leumas, Jordan K MD
Leung, Enoch C MD
Levine, Jennifer B DO
Lightsey, Joseph M MD
Lillo, Sara N MD
Lin, Eric Z MD
Lin, Jenny MD
Liolios, Antonios MD
Liou, Victor MD
Lirette, Ryan W MD
Little, Yvonne M MD
Locrotondo, Tony DO
Lodebo, Bereket T MD
Logan, Danielle R MD
Logterman, Stephanie L MD
Lopez, George MD
Loungani, Rahul S MD
Loy, Brienne J MD
Luce, Lindsay MD
Lyon, Albert W MD
Madbak, Firas MD
Magruder, Jonathan T MD
Maher, James E, III MD
Malenke, Jordan MD
Malik, Sitwat F MD
Mallick, Faryal MD
Mandell, Joanna L MD
Mandiga, Hemalata MD
Maness, Caroline B MD
Mann, Patrice A, MD
Mansour, William L MD
Masiewicz, Spencer A DO
Mathai, Abraham MD
Mathew, Taniya S MD
Mattox, Dexter MD
Maurente, Diego N MD
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Maxwell, Robert A MD
Mayol del Valle, Miguel A MD
McArthur, Erica MD
McBride, Donald W MD
McGrail, Kaitlin MD
McKinney, Terry K MD
McLaren, Matthew D MD
McLaughlin, Ryan C MD
McLean, Keith A MD
McLeod, Cara DO
Medarametla, Srikanth MD
Medina Vega, Rita E MD
Mehta, Akshat J MD
Mehta, Puja MD
Mennie, Peter A MD
Merrell, Desiree MD
Merritt, Clint M MD
Mian, Amir R MD
Michel, Kendra E MD
Milad, Abdulhamid MD
Miller, Janae E MD
Miller, Janelle DO
Miller, Jessica MD
Mishra, Mitushi MD
Mitton, Arielle R MD
Mize, George W MD
Moffatt, Victoria L MD
Mojicar, Luis A MD
Mole, Angelique A MD
Monu, Nicholas MD
Moore Padilla, Michelle M MD
Moore, David C MD
Morisset, Jean-Philippe E MD
Moss, Renee F MD
Motamed, Amy L DO
Muehrcke, Cecile S MD
Mullens, Frank MD
Murphy, Colin G MD
Mushref, Malek MD
Nagy, Celeste Z MD
Najjar, Nadine MD
Narayan, Dwayne A MD
Nazinitsky, Allison L MD
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Nelson, Corrine R MD
Nelson, Daniel G MD
Netherton, Cynthia L MD
Nguyen, Christina MD
Nimmagadda, Neelima MD
Noto, Michael J MD
Novack, Craig DO
Nwanne, Ogochukwu Y MD
Nyange, Christabel E MD
Obetta, Kenechi MD
O'Brien, Colin W MD
Ogbuchi, Samuel I, Jr. MD
Okanu, Ngozi E MD
Omoike, Osereimen MD
Ondersma, Ross M MD
Orange, David MD
O'Shea, Casey MD
Osteen, Erin S MD
Otekeiwebia, Anthony S MD
Ou, Jocelyn MD
Oyefule, Omobolanle MD
Oza, Bhishma DO
Padro Diaz, Willma L MD
Paletta, Nina J MD
Pandit, Trailokya N MD
Parikh, Amy DO
Park, Michelle MD
Parks Ballard, Bari A MD
Pasculli, Rosa M MD
Patel, Dil D MD
Patel, Gopi A DO
Patel, Harsh N MD
Patel, Harshang J MD
Patel, Janak R MD
Patel, Jay D DO
Patel, Jigar J MD
Patel, Kevin K MD
Patel, Kunal MD
Patel, Nilbhi MD
Patel, Parag D DO
Patel, Radhika DO
Patel, Rooshi A MD
Patel, Vatsal G MD
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Patel, Viral M DO
Payabyab, Eden C MD
Payne, Zachary J DO
Pearce, Melissa W MD
Pearlman, Justin D MD
Pershad, Valerie MD
Peters, John M MD
Petrillo, Sara MD
Pham, Cung B MD
Pham, Jamila-Duyen MD
Philpott, Natalia G MD
Picon, Michelle M MD
Pina, Paloma G MD
Pittman, Patricia D MD
Pole, Ginger L DO
Pollack, Jason M MD
Powell, Benjamin C MD
Powell, Melissa A MD
Powell, Stephen L MD
Prow, Harold W MD
Pullamaraju, Swati MD
Puttu, Sumathi MD
Rabbani, Shimool A MD
Rageh, Abdulrahman MD
Rahman, Sabreen R MD
Ramalingam, Vijaya Sivalingam MD
Ramos, Anika M MD
Rana, Niteshkumar MD
Randazzo-Burton, Theresa MD
Ranganath, Shashi MD
Ranpura, Vishal N MD
Rao, Sudhir R MD
Rashid, Ahmad M MD
Rathee, Vaishali MD
Reese, Erika S MD
Rehman, Faiz U MD
Rekito, Anthony W MD
Richman, Louis MD
Ridge, Margaret MD
Ridley, Wesley A MD
Ritchie, James M DO
Rizvi, Kashan H MD
Roberts, James K MD
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Robinson, Julie C MD
Rodriguez, Rey L MD
Romancik, Jason T MD
Roque Gardner, Annelys MD
Rosenblum, Richard S MD
Ross, Justin C DO
Royes, Kareem N MD
Rudolph, Adam M MD
Ruiz Vega, Joshuam A MD
Sadeghi, Nick A MD
Sahu, Joya MD
Salabei, Joshua MD
Salas, Stephanie A MD
Salastekar, Ninad V MD
Salcin, Sameena H MD
Samaddar, Ted S MD
Samra, Hasan MD
Sanchez Rivera, Jarvis J MD
Sanders, Aaron MD
Sanders, Jason C, II MD
Sandler-Wilson, Carla L MD
Santy, Eleanor E DO
Sarang, Trushar MD
Sardar, Muhamamd R MD
Sarlay, Robert, Jr. MD
Sarrafi, Madhis MD
Scelsi, Christopher L DO
Schaheen, Basil W MD
Schaheen, Emily C MD
Scheuer, Kim MD
Schley, Stacey MD
Schunn, Christian D MD
Schwartz, Joel DO
Seibolt, Lucas MD
Selhorst, Christopher MD
Sepulveda, Ernesto A MD
Sergeyenko, Yevgeniya MS
Shafran, David M MD
Shah, Freny MD
Shah, Niral MD
Shandley, Lisa M MD
Sharma, Saurabh MD
Sharp, John R, II DO
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Sheets, Ryan O MD
Sheffield, Sandra L DO
Shelton, Emily A MD
Shelton, Julie E DO
Sheth, Eshani DO
Shiekhmohammed, Mohammed MD
Shields, Jessica A MD
Shull, Hannah E MD
Shulman, Lee P MD
Sidile, Jabulani MD
Silverman, Bruce A MD
Simba, Brian MD
Simpson, Megan K DO
Singh, Shashank S MD
Singh, Simren J MD
Sledge, Caitlin M MD
Smalley, Arion A MD
Smith, Collin M DO
Smith, David N MD
Smith, Leslie DO
Smith, Nathan E MD
Smith, Rachael C MD
Smith, Stacey L MD
Sohn, Yoojin MD
Soifer, Gregg A MD
Songer, Emily A MD
Sood, Rajiv MD
Spelts, Anna F MD
Squier, Samuel B MD
Stangeby, Megan A DO
Starr, Amy DO
Statler, James R MD
Steely, June M MD
Sternad, Lindsay A MD
Stevenson, Jason M MD
Strange, Liberty F MD
Strother, Angela W MD
Stroud, Jennifer N MD
Stubbs, James W MD
Suah, Ashley MD
Summers, Kevin M DO
Summey, Robert D MD
Surapur, Kawanjit K MD
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Surti, Amy J DO
Sutaria, Tarangi D MD
Sutton, Gregory MD
Swanson, Benjamin F MD
Swavely, Natalie MD
Tang, Anita MD
Tanksley, Parris MD
Tarplin, Sarah J MD
Tarr, Andrew M MD
Terwilliger, Toby D MD
Tesfay, Meron A MD
Testini, Paola MD
Thakkar, Yesha M DO
Thayer, Wesley P MD
Thomas, Julien R MD
Thomas, Justin L MD
Thomas, Orlando W DO
Tillman, Marah C MD
Toister, Shira S MD
Tolu-Ajayi, Christine I MD
Torres, Eliud MD
Tossing, Christopher M MD
Toussaint, Marissa A MD
Tramontana, Jane MD
Traore, Elizabeth J MD
Trissell, Brian MD
Truitt, Brittany A MD
Trzebinska, Danuta MD
Tseng, Hayley K MD
Tupchong, Keegan MD
Twum-Ampofo, Jeffrey MD
Udoetuk, Sade MD
Ugwu, Chidiebere V MD
Umar, Shaheen I MD
Valenzuela, Ashley D MD
Van Rijn, Kilian MD
Varanasi, Balavittal MD
Vardhana, Harsha MD
Verma, Nandini MD
Vines, Tyler B MD
Viqar, Sehrish MD
Vitantonio, Daniel S MD
Vokes, Jordan MD
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Vuncannon, Danielle M MD
Wagner, Andrew F MD
Wagner, Krystn R MD
Wagner, Lori F DO
Waheed, Salman MD
Wahlmeier, Steven T MD
Walding, Jeffery L MD
Wang, Jeffrey MD
Webb, Chelsy MD
Weinstein, Joseph S MD
Welsch, Michael MD
White, Jessica J DO
Whittemore, Brianna S MD
Wilhoite, David A MD
Williams, Jessica D MD
Wilson, Elizabeth A MD
Wilson, Katherine M MD
Winbush, Nicole Y MD
Witter, Daniel MD
Wolff, Erin MD
Wong, Waikeong P MD
Wright, Brian D MD
Wright, Yonte B MD
Wroblicky, Peter T MD
Xu, Ashley MD
Yesus, Yohannes W MD
Yoshii, Hikari MD
Young, Lisa A DO
Yousefi, Shadi MD
Yu, Jason L MD
Yu, Jonathan DO
Zafar, Blal A MD
Zamfir, Radu A DO
Zayas-Borges, Paola Y MD
Zemlyak, Alla Y MD
Ziegler, Dean W MD
Zolak, Jason MD
Zorrilla, Andres MD
Zuniga, Joshua V MD
NURSE PROTOCOL ADVISORY COMMITTEE Dr. Norman presented the Nurse Protocol Report:
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The Board took the following actions:
The Committee recommended the following:
1. An APRN is interested in establishing a medical spa in the state. She inquired with questions and
requirements, MDO and delegating authority. The Board referred her to the FAQ’s and the laws
and rules. Please find below the questions the Board's review and consideration.
The following Form C’s were approved:
❖ Diaz, Betsy
❖ Evans, Angela
❖ Fass, Alexandra
❖ Hartline, Amy
❖ Kairu, Linet
❖ McDaniel, Erica
❖ Oestrelch, Krystal
❖ Rizkalla, Chelsa
❖ Smith, Caitlyn
❖ Wilson, Suzzane
The following Form C’s were not approved:
❖ Evans, Angela (thermiRF, Cellfina, Skin-Only Blepharoplasty, Local Lipo, Thread Lifts and
Minor office procedures)
❖ Louis, Charlot
The Committee reviewed and approved the following protocols under the provision of O.C.C.A.
43-34-25.
APRN Delegating Physician
Berry, Crystal Allen Lavender, Jr., DO
Clark, Cynthia Muhammad Jamil, MD
Clayton, Anna Erik Bauer, MD
Freeman, Julie Timothy Taylor, MD
Morgan, Dana David Faulk, MD
Thrift, Alicia David Faulk, MD
The Committee determined that the following protocol agreements meet the provisions of
O.C.G.A. 43-34-25 with changes.
APRN Delegating Physician
Buffington, Howard Dhru Girard, MD
Davis, Jamil A. Patrice Daisley Shongo
Felder, Joylove Muhammad Jamil, MD
Harrison, Shirley Charles Jackson, Jr., MD
Hinton, Cindy Allison Dupont, MD
Nelson, Stephanie Livingstone Rasalam, MD
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Rafford, Autumn Leticia Lindsey, MD
Wheeler, Amy Kipp Slicker, DO
Wildes, Deanna Anthony Avino, MD
Williams, Nicole Ganiat Ajayi, MD
Woolwine, Megan Farhan Qureshi, MD
The Committee determined that the following protocol agreements do NOT meet the provisions of
O.C.G.A. 43-34-25.
APRN Delegating Physician
Barra, Jessica Lanre Udu, MD
Clark, Melissa Kayln Lane, MD
Doirin, Sabine Franckel Val, MD
Miller, Tanya Ram Bishnoi, MD
Natson, Kimberly Sandra Bohsterngel, MD
Sumner, Erin Muhammad Jamil, MD
Wright, Anna Bryon Evans, MD
Yinusa, Bisi Otis Powell, MD
Yngayo, Kathleen Kenneth Dinella, MD
Protocols Administratively Reviewed:
The following protocol agreements meet the provisions of OCGA 43-34-25:
APRN Last APRN First Supervising Physician Name
Acree Lisa Osaguona Osa
Aldaco Emie Maria Alban
Andrews Rachel Marlon Fisher
Applegate Michael William Mcalvany
Austin Nateka Amy Blanchard
Bailey Jean Sreevalli Dega
Barber Charlton Asif Qadri
Barnes Felecia James Collins, Jr.
Barrow Michael Eugene Sun
Beckett Davies Summer Forrest Toca
Berg Shawna Fredrick Makori
Black Jennifer Glenn Parris
Bonner Holly Madhusudan Chandora
Brown Robert Wael Alijishi
Caddell Casey Armando Castillo Jr.
Cadet Brigitte Manivannan Veerasamy
Caoile Michael Loan Vu
Carroll Dana Yusef Williams
Chmiel Edyta Lee Jacobs
Culpa-Bondal Maria Angela Dawson
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APRN Last APRN First Supervising Physician Name
D'Annunzio Shannan Marwan Kazimi
Davila Teresa Wael Alijishi
Dixon Krystle Larry Smith
Dowden Phyllis Alexis Atwater
Drogoul Anastasiya Saad Hammid
England Kayla Christopher Randolph
Evans Eboni Garland Martin
Fajardo Judy Srilatha Nadipineni
Fincher Miranda Salvatore Assorgi
Flynn Adam Jeffrey Lowery
Fortenberry April Heather Ford
Francis-Freckleton Nicole Shanker Unnikrishnan
Franklin Scott Xing Gao
Fullard Nicole Salvatore Assorgi
Fuller Megan Mark Fugate
Fults Selvi Ryan Borst
Genas Kenesia Tiffany Parks
Giarla Kathleen Joshua Jackson
Giles Natasha Mehmood Mehdi
Green Faqueta Wayne Denton
Grove Misty Robert Hanrahan
Grove Misty Wael Alijishi
Grovenstein Evan Lonnie Sipsy
Haddad Amanda Karen Baker
Harris Valesha Gustavo Pradilla
Harris Valesha David Adamson
Harrison Jessica Michael Boggs
Harrison Tanya Lanashia Wells
Haskin Justin Steven Powell
Hawkins Rebekah Daniel Gordon
Heath Ashleigh Gabriela Pena
Henry Sherre Aderajew Taddesse
Herrin Lauren Atul Devani
Holbrook Feather Kanwar Gill
Hughes Michael Heather Hall
Jackson Ashley Ramanpreet Dhindsa
James Lequawn Michael Moody
Jiles Sierra Gehrig Harris, Jr.
Jones Morgan Norvin Ona
Jones-Harris Juanita Meesha Gwan-Nulla
Kell Kayla Charles Gomez
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APRN Last APRN First Supervising Physician Name
King Jillian Christopher Inhulsen
Kirkland Halei Salvatore Assorgi
Kosenski Butts Kira Audrey Henson
Any Old/New Business
The Committee discussed the FAQ’s and the changes that are forth coming.
PHYSICIAN ASSISTANT ADVISORY COMMITTEE Dr. Antalis presented the Physician Assistant Committee report.
The Board took the following actions:
Approved the following applications for initial licensure with a supervising physician:
PA Supervising Physician
Taylor Abu-Alrub Shalabh Chandra
James Aksamit Jonathan Sevransky
Jaymie Bailey Hunter Champion
Hallie Bain Martin Hardy
Jessica Baum Scott Barbour
Faith Boone Laurence Busse
Megan Boswell-Betts Franklin Harkrider
Robert Bowen John Sapp
Morris Chemell Steven Magilen
Bailey Dickinson Jay Goldstein
Marc DiFronzo Vlastimil Smetka
Joseph Ferguson Yetunde Orimogunje
Gabriella Goldberg Vikram Sabarwal
Justin Hamil Lansing Hillman
Alexis Hess Dana Kumjian
Mary Horne Waseem Ghannam
Christine Landgren Lee Kelly
Tiwana Miller Tamar Jackson
Mary Peabody Timothy McCullough
Devin Perry Ahmad Mohammad
Samuel Roberts Keith Lamberson
Dar Robinson Emily Lagergren
Cierra Ryan Jean Koff
Dillon Veal Jerry Mullis
James Weegar Waseem Ghannam
Approved the following applications for initial licensure without a supervising physician:
PA
James Akins
Rabail Altaf
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Douglas Amis
Lauren Anderson
Enoch Asiedu
Jenna Ashton
Adewumi Bakare
Brian Baldwin
Jeremy Bass
Alemtsehay Bayyan
Katherine Browne
Courtney Calote
David Conn
William Crunk
Mitchell Daniel
Grace Fantl
David Goins
Emma Goldman
Giovanna Golem
Kaitlin Hagan
Nicole Hall
Kimberly Harvey
Erin Hembree
Sarah Inglesby
Marc Marchioli
McKenna Moe
Brittany Moon
Emily Morris
Claire Murphy
Nadege Nerette
Brandon Nieves
Nili Nourpavvar
Madison O’Brien
Karja Peart
Polina Rubin
Natalie Schoeffler
Thomas Sheridan
Brandon Smith
Megan Srongprapa
Lance Stephens
Pooja Unjiya
Ryan VanderMark
Kelly Stevens
Approved the following applications for licensure reinstatement with a supervising physician:
PA Supervising Physician
Chelsea Stoever James Stoever
Kara Whyte Harry Wingate
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Approved the following applications for additional duties:
David Alexander- Michael Hardee
Stress Tests
Cheyne Charles- Gagandeep Joshi
Stress Tests
Brandi Eaton- Jeff Donohue
Pellets
Caleb Etheridge- Mark Floyd
Shoulder Injections
Hip Injections
Trochanteric Injections
Knee Injections
Lauren Fisher- Melissa Babcock
Chemical Peel TCA
Kybella Cosmetic Injections
Neurotoxin Injections
Dermal Filler Injections
Hannah Galvan- Deepa Patel
Central Lines
Intubation
Arterial Lines
Colleen Hill- Sara Auld
Intubation
Arterial Lines
Central Venous Catheter
Nives Keron- Amelia Langston
Bone Marrow Biopsy
Emily LeCraw- Alexandra Feliciano
Aesthetic Injection
Kenneth Phelps- Robert Kim
Medical Liver Biopsy
Allison Smith- Michael Bosley
Paracentesis
Thoracentesis
Port Placement
Moderate Sedation
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Andrew Woodham- John W. Barton
Port Catheter Removal
Anthony Ambrose- Sachin Lavania
Paracentesis
Thoracentesis
Chest Tube Insertion
Intubation
Collen Hill- Sara Auld
Paracentesis
Thoracentesis
Chest Tube
Other Business:
Tatjana Cotta-Connors
Email Response Received: April Board Recommendation - 240 Shadowing Hours
Answer: Permitted to table application and resubmit at later date.
Nitasha Burney-Fleming
Email Response Received: Request for Clarification
Answer: PA responsible to notify the board regarding new alternate physicians. Submit AC1 form.
GCMB (Proposed Statement/Policy)
240 Shadowing Hours Frequent Questions
Answer: (1) Yes, prior shadowing hours may be included. (2) Reference letters from previous
supervisors must be current, no more than three years old; permitted to use colleagues but must be
MD/MO. (3) Shadowing supervisor would need to sign off on all performed duties when obtaining
required clinical hours. (4) No, current CME hours (80) have not met standard.
GCMB (Alternates/AC1 Processing/Postings)
Answer: Table to June board meeting for further discussion.
Approved the following Add/Change applications:
PA Supervising Physician
Julie Abrahamson Contessa Metcalfe
Jordan Aigner Stuart Lehn
Marissa Akin David Katz
Ramon Alarcon Vandy Garrney, II
Joseph Alfera Mark Firth
Shelina Arnold Joshua Hammond
Cristina Baldassarri Bhavik Shah
Morgan Baker Jan Mayfield
Margarete Bane William Dozier
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Tara Barton Robert Deal
Negin Bauer Eric Nelson
Stephen Benton Srikant Nannapaneni
William Benz Heywood Gay
Kathryn Berman Barry Renz
Easton Beshears Ronnie Hendriz
Nicole Black Abhik Dahr
Ashley Boachie-Adjei Carmen Kavali
Elizabeth Bonin Charles Leewood
Deborah Bowman Robert Dourron
Bradly Bowser Justin Carroll
Cynthia Brand Donald Browning
Charle Cameron Bennie Brown
Liz Chapman Bisan Salhi
Amanda Cornwell Dodd, Richard
Kinsley Cowart Rebecca Lopez
Kinsley Cowart David Schmidt
John Cox, Jr. Woody Francis
Thomas Cox Daquesha Chever
Victoria Coyne Christa Jillard
Sarah Craven Christina Wu
Amanda Culbertson Alan Farabaugh
Amanda Culbertson David Powell
Bartlett Davis Loy Cowart
Bartlett Davis Glen Bunn
Henry Davis George Cierny
Phuong Dinsfriend Amit Singh
Amy Duane Olufunke Orimagunje
Gary Dutka Michael Hamm
Christine Ertley Neela Natarajan
Olufunke Fadoju Karla Booker
Joy Ford Jacqueline Harris
Meredith Foushee Sara Friend
Meredith Fox Christina Rich
Megan Gaines Jeffrey Goldberg
Hannah Galvan Deepa Patel
Rachel Garner Joe Huong
Sonthonax Gay Radhwan Alrubaye
Janai Gibson Mitzie-Ann Davis
Andrew Goodner Andrew Klein
Allison Gosnell Michael Maceroli
Kellly Graham Jin Park
Shawnna Greco Dev Mangalat
Thomas Greene Kenneth Benjamin
Leah Gumucio Cassie Campbell
Rebecca Habte Jason Burch
Patricia Hagerman Rene Latoni
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Bibi Haniff Melvin Echols
Vaban Harris Krupa Desai
Nathan Hayden Michael Duggan
Kristen Healy Thinh Nguyen
Colleen Hill Sara Auld
Alexandra Hodson Venu Velagapudi
James Hunter Mala Kaul
William Hutcheson Robert Pilcher
Stephanie Hyson-Guevara Amber Orquia
Brian Jamail Lindsay Dowis
Robert Jones Ajay Handa
Jackie Kennedy Patricia Evans
Nives Keran Amelia Langston
Rebecca Klisovic Yevgeniya Berkovski
Michelle Kowal Jeffery Gladstein
Wendi Kretzschmar Peter Kim
Justin Kwon Shawn Kim
Emily LeCraw Alexandra Feliciano Aponte
Julie Lovelly Allison Ventura
Aaron Morton Mark Cardi-Scheible
Samuel Muller Jamil Muhammad
Nhung Nguyen Joe Huong
Brett Puckett Kellie Middleton
Hilliary Rounds Allison Ruch
Chereese Rowe Letty Peterson
Brandy Scott Richard May
David Wade Gonzalo Villalobos
Justin Vinomon Daniel Carothers
Nicole Rivera Neal Patel
Erica Pena Muhammad Usman
Carla Perry-Davis Muhammad Usman
Courtney Rejzer Daquesha Chever
Ava Tompkins William Benedict
Milajurine Lindsay Fred Kennard
Dhara Patel Reginald Strother
Priya Patel Shirley Harris
Angela Scarboro Yulianty Kusuma
Wallace Torbert Riliwanu Aliu
Trenton Moore Kris Manlove-Simmons
Shivani Patel John Lawrence
Shawna Silverman Deronda Brown
Frankie Walls Martha Shuh
Paul Schofield Stephen White
Brandon West Gena Volas-Redd
Renee Wright Julie Crusor
Haley O’Reilly Christina Wu
Patrick Murray Michael Duggan
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John Pena Stephen Skidmore
Jared Robinson Richard Shack
Emily Shull Ansa Anderson
Questa Tingler Catherine Dickens
Madison Wickline Siddharth Patel
Salihu Yarima Raymond Sykola
Kianna Lawson Allison Ventura
Cody Leatherwood Kathryn West
Reagan Marienga Onkar Khullar
Kyle McGovern Allison Ventura
Rachel Metz Darrell Scales
Melissa Pietro Enrique Martinez
Isabel Soles Gabriela Pena
Sara Stephano Andrew Ostrowski
Megan Tunstill Carmen Mays
Christina York Jason Burch
Brittany Swicegood Arthur Chandler
Jarrod Luttjoham Gerald Filmore
Skyler Lamberth George Vijia
Erin Love Kim Peter
Joseph Nyankum Martha Crenshaw
Jeremy Palmer Afolarin Banjoko
Michael Shibley Frederiek Turton
Adam Wyble Patricia Evans
Lauren Upchurch Mara Schenker
Ericka Ravenell Mark Lelli
Alissa Traina Stephen Skidmore
Kolyse Wagstaff Alexis Shaffer
Andrea Ledbetter Maan Jokhadar
Scott Lewis Lissa Murphy
Sharon Masinelli William Dinsfriend
Jennifer Miller Stuart Lehn
Trisoni Miller Kenneth Grotz
Meagan O’Brien Naima Cheema
Lisa Piper Heather Horton
Brett Scoggins Joshua Hammond
Ian Thomas Michael Nordsiek
Lauree Thomas Seth Eisenberg
Keisha Wilkerson Amit Singh
Jean Lee Franklin Harkrider
COSMETIC LASER ADVISORY COMMITTEE Dr. Gross presented the Cosmetic Laser Committee report as a motion and it carried unanimously.
The Board took the following actions:
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Approved the following for Assistant Laser Practitioner –
Taylor Benning
Grecia Camacho
Marsha Charles
Sadie Colan
Kelly Eleazer
Samantha Hammond
Demetrius Hull
Shona Jackson
Cindy Lambros
Linsey McCarthy
Malea Moore
Liliana Perea-Gallego
Kaylee Pirtle
Vivian Carole Reddick
Desiree Riera
Kimberly Roelofs
Meirielly Teixeira
Allik Townsend
Huyen Tran
Sheniqua Mary Turner
Approved the following for a reissue of Assistant Laser Practitioner –
Kalen Wheeler
Approved the following for Senior Laser Practitioner –
Elizabeth Beringson
Pamela Lynn Brown
Eric Dennin
Approved the following for a reissue of Assistant Laser Practitioner pending additional information
L.L.
Other Business:
The Board requested the following assistant laser practitioners (licensed at the March 4, 2021
meeting) refrain from laser practice until the GA RN license is issued.
ML
BS
The Board recommended that for questions regarding micro-needling by estheticians or cosmetologists,
from Natalie Majeed should review OCGA 43-10-1 for the regulations for the practice of estheticians
and master cosmetologists. If the specific information cannot be found, she should consult her own legal
counsel. For questions regarding ablative laser procedures, the following practitioners can perform:
Licensed physicians; licensed physician assistants with a Board-approved Basic Job Description and
additional duty request; and licensed nurse practitioners with a Board-approved nurse protocol
agreement and Form C with additional procedures.
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Erika Rose and Patrick Burns demonstrated the Futura Face device. The Board reversed a previous
decision and determined that the operator for this device would not require a cosmetic laser practitioner
license.
RESPIRATORY CARE ADVISORY COMMITTEE Dr. Dalton presented the Respiratory Care Committee report as a motion, seconded by Dr.
Retterbush. The Board accepted the report by unanimous vote.
The Board took the following actions:
Correspondence:
• Email question from Crystal Dawn regarding scope of practice for RRTs and transport RRTs. The
Committee determined the Medical Director will advise accordingly depending on program for
transport teams.
• Email question from Sandra Jacobs regarding hiring RT students prior to graduation. The Committee
determined Ms. Jacobs should refer to rule 360-13-.12(2)(h).
Practicing without a license; fine and consent order
Burgess, Claude
Reinstatements:
Bressler, Denise
Merriweather, Keneshia
Alemu, Ermias
Kizziah, Stacie
Wood, Whitney
Yisrael,Yosef
Musa, Ayub
Harris,Leonna
Brunson, Arthur- pending additional information
Temporary Licensure; - pending additional documentation
Sodemann, Gretel
Johnson, Kedra
Lesesne, Kiah
Edwards, Alicia
Regmi, Karuna
Wiley, Yatasha
Finley, Leah
Temporary Licensure; Gwinnett Technical College; pending Form A
Choudhury, Tuly
Ashong, Josephine
Utley, Steven
Yara, Tomokazu
Young, Shanikko
Long, Brittany
Nguyen, Nghi
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Agbomson, Mianken
Abuajah, Terrence
Keyhan, Maryam
Basha, Emma
Brownwest, Asaye
Dang, Thuy
Crespo Bezares, Marlette
Hines, Lakeisha
Harter, Hope
Jeanty, Antonio
Jagroo, Nadia
Yun, Yamada
Temporary Licensure; Middle Georgia State University; pending Form A
Dixon, Courtney
Coleman, Hannah
Allen, Jasmine
Appiah, Ashley
Quayson, John
Walker, Mi’Kela
Whatley, Jacob
Marrone, Danielle
Temporary Licensure; Columbus Technical College; pending Form A
Jenkins, Tyrel
Neisent, Jonathan
Berry, Jessica
Booker, Leeia
Bailey, Heidi
Delly, Clinton
Full Licensure:
Adams, Tabatha
Clark, Rodney
Garrick, Amanda
Hancock, Derrick
James, Kayla
Pace, Felecia
Ross, Elizabeth
Turner, Felecia
Dickinson, Allison
Jackson, Garnette
Skoe, Teresa
Gilbert, Leah
Brown, Kimberly
Crosthwaite, Christy
Grayson, Timothy
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Harris, Bria
Jenkins, Kaitlin
Moran, Ashley
Paff, Amy
Runels, Laurel
Williams, Jacqueline
Corbin, Austen
Nelson, Maranda
Keeling, Ashley
Bowen, Sheryl
Atkins, Michele
Griffin, Lisa
Holmes, Mallory
Moss, Sandaireca
Palmisano, Jennifer
Stallworth, Brittania
Pedigo, Karrie
Greene, Barbara
Waldroop, Debbi
Howard, Michelle
McCallum, Detaurius
Barimah, Jasmine
Carter, Dyonna
Frink, Adam
Placide, Ashley
Wooten, Bailee
Massaley, Hawa
Guy, Diane
Bickel, Jennifer
Cassidy, Jonathan
Garrett, Latrice
Hamilton, Nicholas
Hull, Terence
Merrick, Ashley
Newland, Crystal
Reed, Pandora
Thomas, Lavellie
Wright, Amanda
Young, Melanie
Cleare, Ronesha
Karjala, Lindsey
King, Rochelle
Pitts, Amy
Hawkins, Erin
Cooper, Dyamond- pending additional documentation
Dalton, Pindell- pending additional documentation
Brown, Domanique- pending additional documentation
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Almakrami, Abdulaziz- pending additional documentation
Dodson, Valerie- pending additional documentation
Freeman, Marcella- pending additional documentation
Hall Shanda- pending additional documentation
Stinger, Joyce- pending additional documentation
Administrative Upgrades
Brooke Okorley
Benjamin Giraud
Erica Armstrong
Promise Garner
Delaney Bell
Nerixa Portillo
Timothy Hester
Jessica Watkins
Paulos Weldegiorgis
Justin McNair
Kayla Roscoe
Andrea Scott
Natasha Dixon
Yury Garcia
Cassidy Callahan
Angeline Mamaril
Carlos Wong
Jackie Anderson
Matthew Rice
Aqsa Iqbal
Qui Phan
Cherry Bryant
Amelia Robinson
Kathryn Lowe
Pamele Trujillo
Alexis Brent
Christopher Owen
Kimberly Henson
Yilak Assefa
Carol Taylor
Matthew Crockett
Hailey Wright
Brian Calizo
Michaell Choi
Aja Lippitt
Suzan Alsanoussi
Josephina Addo
Nicole Gaston-Howard
Chelsei Poole
Alyssa Johnson
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William Couse
Amber Prickett
Kisha Robinson
Deidra Mathis
Christina Montgomery
Lisa Flood
Quinetrious Thomas
PERFUSION ADVISORY COMMITTEE Dr. Retterbush presented the Perfusion Committee report as a motion and it carried unanimously.
The Board took the following actions:
Approved the following for Initial Perfusion Licensure:
Brittany Miller
ACUPUNCTURE ADVISORY COMMITTEE Dr. Bostock presented the Acupuncture Committee report as a motion and it carried unanimously.
The Board took the following actions:
Accepted the following quarterly reports:
Abigail Hurewitz
Lu Phoun
Janna Torontali
Approved the following for limited acupuncture licensure:
Michelle Arms
Byeonghong Cho
Approved the following for initial acupuncture licensure:
James Kelsey, Jr
Kyungja Yun
Michelle Zamora
Other Business:
The Board accepted as information the list of limited licensees and supervisors.
The Board determined that an acupuncture licensee may see and treat patients in their home provided the
licensee’s insurance carrier approves and that local statutes regarding residential areas are followed.
PAIN MANAGEMENT COMMITTEE Dr. Collins presented the Pain Management Committee report as a motion. The Board accepted
the report by unanimous vote.
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The Board took the following actions:
Correspondence:
• Question from Timothy Ward, MD regarding current state policy on prescribing/refilling
Schedule II medication within 90-day period. The Board determined Dr. Ward should
refer to rule 360-3-.06(2)(f).
• Question from Ty Williams-King regarding whether Dr. Rasean Hodge’s can continue
treating patients via online. The Board determined Dr. Hodges’s should continue to
comply with rules previously set forth.
Approved the following applications:
Pain Clinic Name
Alliance Spine and Pain Centers- Dacula
Summit Spine & Joint Centers- Marietta
Summit Spine & Joint Centers- Rome
Lic # 387 Summit Spine & Joint Centers-Decatur
ADD Physician, Jose Mathew
ADMINISTRATIVELY APPROVED APPLICATIONS
License # Pain Clinic Name
185
Rehabilitation Physicians of Georgia, PC
ADD PA, Helen Zhang
224
Harbin Clinic, LLC
ADD APRN, Courtney Hann
379
Duluth Medical Center, LLC
ADD Practicing Physicians, Bradford Gould & Muhammad Usman
412
Summit Spine & Joint Centers
ADD Practicing Physician, Chad Lee
530
Summit Spine & Joint Centers
ADD Practicing Physician, Thomas Cheriyan
377, 411
Summit Spine & Joint Centers
ADD APRN, Deborah Wilkens
ADD Practicing Physician, Gabriel Marrero
473
Summit Spine & Joint Centers
ADD Practicing Physicians, Thomas Cheriyan, Adam Gover, and Srinand
Mandyam
258
Summit Spine and Joint Centers
ADD Practicing Physicians:
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Gerald Chai, Thomas Cheriyan, An Duy Do, Adam Gover, Gabriel Marrero
ADD PA Scott Linacre
ADD APRNs, Dalandra Belcher, William Wikoff & Deborah Wilkens
447, 465
Spectrum Spine and Pain Care
DELETE Practicing Physician, Simon Willis
410
Summit Spine & Joint Centers
ADD Practicing Physicians,Thomas Cheriyan, and Amod Sureka
ADD APRNs, Dalandra Belcher and William Wikoff
504, 512
Summit Spine & Joint Centers
ADD APRN, Chenoa Dickerson
153
Pain Management and Wellness Center
DELETE Practicing Physicians, David Katz, Naureen Adams, and Victor
Leslie
153
Pain Management and Wellness Center
ADD Practicing Physician, Richard Campbell
533
Spine and Orthopedic Center
DELETE Practicing Physician, Pran Nath Sood
195
Care Medical Center
ADD APRN, Fran McPherson
Other Business:
The Board decided the staff will include a face sheet on the Renewal Form explaining the consequences
of falsifying questions on the form.
GENETIC COUNSELORS ADVISORY COMMITTEE
Dr. Deloach presented the Genetic Counselors Advisory Committee report.
The Board took the following actions:
Draft Separation Notice
Motion Ms. Bellcross, seconded Ms. Brickle and motion carried to approve the new form.
CGC Examination Information
Ms. Bellcross made the Committee aware of changes the CGC Examination has made. The Committee
tabled the discussion until the June meeting to allow everyone an opportunity to review the changes and
to see if these changes will impact the current rules.
The following applications were approved:
Brittany Hansen
Divya Abraham
Katherine Agre
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Colleen Blanchard
Lauren Bogue
Chloe Dugger
Brittany Hansen
Emily Hendricks
Julie Moroney
Ami Narayen
Haley Pace
Rachel Reaglee
Amanda Roth
Audrey Schlachter
Grace Tan
Nicole Wengrofsky
The following application is approved pending additional information:
Rachael Cabey
There was a question on the online form, if there was a limited number of employment items that can be
added to the application? The staff will follow up and let the Committee know.
LAW ENFORCEMENT ADVISORY REPORT
The LEAR report was presented as a motion by Dr. Marshall and was seconded by Dr. Harbin. The
Board accepted the report by unanimous vote. The Board took the following actions.
1. 20162317 - Deny Request
2. 20201264 - Release information
3. 20201451 - Release information
4. 20200675 - Release information
5. 20210065 - Approve
6. 20180433 - Deny Request
7. 20210098 - Refer to Law Enforcement
8. 20210292- Refer to Law Enforcement
9. 20210182 - Release information
INVESTIGATIVE INTERVIEW REPORT Dr. Retterbush, presented the Investigative Interview report as a motion, and was seconded by Dr.
Collins. The Board took the following actions.
20180676 Close 20200608 Referred to AG’s Office
20200166 Letter of Concern 20201094 OMPE
20201265 Close 20201389 Close
20201404 Letter of Concern 20201485 Further Investigation
20210325 Close 20210455 Referred to AG’s Office
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INVESTIGATIVE COMMITTEE
The Investigative Committee report was presented as a motion by Dr. Harbin and was seconded by Dr.
Marshall. The Board accepted the report by unanimous vote. The Board accepted the report majority vote
with E. Daniel DeLoach, MD only opposing 20191727. The Board took the following actions.
The Board took the following actions.
Close:
20111962 20160548 20170406 20170856 20180137 20181381
20181655 20181703 20190039 20190192 20190588 20190901
20191713 20191715 20191968 20192349 20192371 20192384
20192399 20192461 20192506 20200036 20200515 20200957
20200993 20201000 20201041 20201179 20201374 20201447
20210077 20210116 20210218 20210234 20210268 20210403
20210462 20210509 20210529 20210609 20210699 20210769
20210813 20210824 20210861 20210876 20210889 20210908
20210909 20210910 20210913 20210918 20210939 20210940
20210953 20210973 20210976 20210981 20210985 20210991
20210998 20211096 20211157 20211222 20211237 20211255
20211277
Letter of Concerns:
20190701 20190789 20190917 20200206 20200653 20201571
20201611 20201618 20210176 20210247 20210465 20210521
20210682 20210782 20210863 20210866 20210871 20210883
20210899
Further Investigation:
20201090 20210358
Invite for Investigative Interview:
20210963 20201148 20201536 20210083 20210547 20210900
20210911 20210912 20210205
Table
20210765 20211168 20211221
Referred to Attorney General’s Office
20192393 20192412 20200457 20200475 20210354 20210405
20210435 20211139 20211165 20191727 20201176
Peer Review
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20210963 20182021 20200802 20200964 20201421 20210954
20210377
INITIAL COMPLAINT EVALUATIONS The Board approved the following recommendations.
20210917 20211120 20211123 20211126 20211154 20211158
20211169 20211175 20211180 20211181 20211184 20211188
20211189 20211191 20211200 20211210 20211215 20211220
20211225 20211227 20211256 20211272 20211274 20211283
20211285 20211299 20211315 20211318 20211241 20211049
RECUSALS
Bostock 20210205 20201176 20182021
Dalton 20210765 20210954
DeLoach 20210765
Marshall 20210765
Reisman 20210765
There being no further business, motion Dr. Marshall, seconded Dr. Harbin to adjourn the meeting at
4:13p.m.
__________________________________ ________________________________
Barby J. Simmons, DO LaSharn Hughes, MBA
Chairperson Executive Director
Recorded by:
________________________________________ Phyllis White, Executive Assistant