Georgia Composite Medical Board
Minutes of the March 1 2018 Meeting
1
The Georgia Composite Medical Board (GCMB) held its regular meeting on March 1, 2018 at
2 Peachtree St. NW, Atlanta, Georgia, to consider Medical Board matters.
Board members present:
E. Daniel DeLoach, MD, Chair
J. Jeffrey Marshall, MD, Vice Chair
John S. Antalis, MD
Keisha Callins, MD, MPH
Gretchen Collins, MD
John Downey, DO
Charmain Faucher, PA (ex-officio)
Alexander S. Gross, MD
Thomas Harbin, MD
Rob Law, CFA, Consumer Member
B. K. Mohan, MD
David Retterbush, MD
Joe Sam Robinson, MD
Barby Simmons, DO
Ronnie Wallace, Consumer Member
Management and legal staff present:
LaSharn Hughes, MBA, Executive Director
William Butler, MD, Medical Director
Max Changus, , Senior Assistant Attorney General
Carl Bedingfield, MD, Assistant Medical Director
Tara Burks, Business Analyst III
Karl Reimers, Director of Investigation
Patricia Sherman, Enforcement Manager
David Stubins, Senior Assistant Attorney General
Phyllis White, Director of Special Projects
Doris Williams-McNeely, Senior Assistant Attorney General
Joanna Zackery, Licensure Manager
Board members absent:
Richard Weil, MD
CALL TO ORDER
Dr. DeLoach called the meeting of the Georgia Composite Medical Board to order at 7:30
AGENDA AND MINUTES
Dr. Retterbush submitted a motion, seconded by Dr. Marshall, to approve the agenda of the
March 1, 2018 meeting. The motion carried unanimously.
Dr. Retterbush submitted a motion, seconded by Dr. Antalis, to approve the minutes of the
February 1-2, 2018, meeting. The motion carried unanimously.
CHAIR’S REPORT
Dr. DeLoach discussed the following items with the Board:
The Board reviewed Dr. Downey’s Opioid worksheet guidelines.
Dr. DeLoach appointed a committee to study strategic planning for the Board’s future.
Georgia Composite Medical Board
Minutes of the March 1 2018 Meeting
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Ms. Hughes gave the Board updated formation regarding number of physicians registered with a
DEA and the Prescription Drug Monitoring Program (PDMP). So far 19,530 have registered.
Donald Palmisano, Jr., Executive Director, MAG – discussed a bill that would address Sexual
misconduct issues. Donald Palmisano, Jr., responded with MAG,s efforts to notify their
members.
INTERIM EXECUTIVE DIRECTOR’S REPORT
Ms. Hughes, Interim Executive Director presented the report.
Ms. Hughes updated the Board with bills before the legislature.
1. Stacy Morgan, MD requested Board eligible be removed from his profile. Board
approved the request. to remove.
2. Jeff Lane asked is it legal for a doctor to post signage regarding a request for patients to
leave firearms in their car?
3. Question forwarded from the Georgia Board of Pharmacy regarding classification and
concerns of pre-filled saline flush syringes for use as part of the PIVO procedure.
4. Board reviewed Compressive Review Concerning Prescription Opioid Abuse in Chronic
Pain: An updated review of Opiod Abuse Predictors and Strategies to Curb Opiod Abuse:
Part 1. For information only.
5. Karen Conley can a lab in Florida process a test sent from a Georgia physician. Physician
would have to have a Georgia license.
Dr. Gross motioned to go into closed session. Dr. Marshall seconded the motion and it carried
unanimously. Dr. DeLoach recused.
Dr. Marshall declared open session.
APPEARANCE BEFORE THE BOARD
Dr. Gene Davidson requested an appearance before the Board. Dr. Davidson gave a history of
his background and medical history. The Board members asked questions concerning his current
and future plans. Dr. Davidson responded. Dr. Antalis and Mr.Wallace recused.
Dr. Retterbush motioned to go into closed session. Dr. Marshall seconded the motion and it
carried unanimously.
Georgia Composite Medical Board
Minutes of the March 1 2018 Meeting
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Dr. Deloach declared open session.
Dr. Gross motioned to up hold the Board’s previous decision to deny the application. Dr.
Marshall seconded the motion and it carried unanimously.
RECESS
Dr. DeLoach declared the meeting in recess for the purpose of holding committee meetings.
RECONVENE
Dr. DeLoach reconvened the meeting at 1:30 p.m.
LICENSURE COMMITTEE
Dr. Retterbush presented the Licensure Committee report as a motion. The Board accepted the
amended report by unanimous vote.
The Board took the following actions:
Petitions to Waive Rules:
Petitioner Rule
1. Hoffman, Dustin 360-2-.02 Approved
2. Whitaker, April 360-2-.02 (5) Approved
3. Schwarz, Stephen 360-2-.01(c) Denied
4. Tuttle, Jessica 360-2-.07 (3) Approved
Other business:
1. Coronado, Esmerelda - ECFMG Certification - Does not meet requirements - re required
examinations approved.
2. Attaran, Saina - AGGME program – Will submit Petition to waive rule
3. Gyambibi, Kakra - Accept request to withdraw application.
4. G.W. – Deny
5. R.R – Invite for interview.
6. SS – Invite for interview.
7. MD (Reinstatement application) – Invite for interview.
8. WT - (Reinstatement application) – Invite for interview.
9. TV – Invite for interview
10. Rop, Baiywo – Table
11. Bowles, Theodore – Table
12. Campbell, Ellen – Table
13. Rao, Ramakirshna – Table
14. Rothenberg, Richard – Table
15. TS – Allowed to withdraw application.
Approved Applications for Licensure:
LIC_NBR NAME Designation
Georgia Composite Medical Board
Minutes of the March 1 2018 Meeting
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79774 BURNS, VALERIE CELESTE MD
79775 KALLI, SIRISHMA MD
79776 MALAY, JOSH MD
79777 ALEXANDER, DANIKA LAUREN MD
79778 ALIGETI, SABITHA MD
79779 AQUI, ERNEST ALVIN MD
79780 BARBIER, GREGORY EDWARD MD
79781 BRITTAIN, ERIC MD
79782 CLEARY, RYAN KIM MD
79783 CLARK, ELIZABETH ANNE MD
79784 GOHIL, AJAY D MD
79785 STANTON, RYAN ASHLEY MD
79785 STANTON, RYAN ASHLEY MD
79787 BROWN, JUSTIN BRADFORD MD
79788 BHAT, VIJAY RAJENDRA MD
79789 BLAIR, JORDANA SARAH DO
79790 CARROTHERS, IRENE ATAMAH MD
79791 CLERY, MICHAEL JOHN MD
79792 DAVE, HEMAN MD
79793 DEMARAIS, DEBORAH ANNE MD
79794 SUNDY, RAEL DAVID MD
79795 TAYLOR, BRANDON JAMES MD
79796 WILSON, ANDREW ARMOUR MD
79797 STICKLER, MICHAEL A MD
79798 SANCHEZ-SILVA, MARTHA PATRICIA MD
79799 KAPUR, SEEMA MD
79800 JOHNSON, STEPHANIE MARGARET MD
79801 ADERANTI, MOSES A MD
79802 STEWART, ADRIANA TURTESSA DO
79803 WOODS, GARY MD
79804 SHAH, DISHANT GIRISH MD
79805 HANNA, JOHN MD
79806 ABOUDARA, MATTHEW MD
79807 AMIN, VAIBHAV MD
79808 AHMED, AFTAB MD
79809 BONDER, ADAM MD
79810 AGARWAL, SAMIR MD
79811 WONG, PHILIP MD
79812 WESTON, MICHAEL ANDREW MD
79813 SHIH, GARY WEIFENG MD
79814 GUILLOT, LORI MICHELE MD
79815 BAXTER, MARGARET MD
79816 CARTNER, AGNES MURCHISON MD
79817 AHUJA, MONICA MD
79818 ARNOLD, SONYA ARNOLD MD
Georgia Composite Medical Board
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79819 BEESLEY, STEVEN DANIEL MD
79820 BELKNAP, SAMUEL WEBSTER MD
79821 BERRY, DUNCAN MD
79822 BOBROVNIKOV, VLADIM MD
79823 MARSHALL, JOHN BENJAMIN MD
79824 BRANSON, CHANTALE MD
79825 DOMINGO, LIEZL TERSOL MD
79826 ALI, MUHAMMAD MUSTAFA MD
79827 ALO, KENNETH MARK MD
79828 LATIF, SARAH MD
79829 DO, JENNIFER STRATTON MD
79830 GERBER, MARK BENJAMIN MD
79831 IBANEZ, DELFIN G MD
79832 MAYO, SHAWNETTE MIREILLE MD
79833 NARASIMHAN DIXIT, ADVITEEYA MD
79834 MODLIN, DAVID MORGAN MD
79835 ORILLOSA, SUSAN MD
79836 OSMOND, JOHN D MD
79837 PETE, KARL LYNDELL MD
79838 BEST ROCHA, ALEJANDRO MD
79839 LEI, PENG MD
79840 MANDAWAT, ANANT MD
79841 MONTASER, AHMED ABDELHADY AHMED IBRAHIM MD
79842 SAYEED, JAWEED MD
79843 SULLIVAN, EDWARD ALLEN III MD
79844 WITTE, NATALIE ANN MD
79845 ZHENG, KAREN SIJIE MD
79847 FREEMAN, BRIAN MICHAEL MD
79848 KLASSEN, CHRISTOPHER MD
79849 OJO, OLUWATOSIN MD
79850 PITIYANUVATH, NATARIA MD
79851 MICKELSON, LEAH DO
79852 JORDAN, MARK SAUNDERS MD
79853 GONZALEZ, MAURA ELAINE MD
79854 HENDRIX, JOSHUA MD
79855 HAYES, EARLE WENDELL MD
79856 GABRIEL, JOHN MR MD
79857 HARRUNA, SHAYIBY MD
79858 NUGENT, GRACE COLLETTE MD
79859 ASWATH, GANESH SHREEHARI MD
79860 PRABHAKAR, PRANAY MD
79861 BOSHELL, BILL HUNTER MD
79862 CAMPBELL, PORSCHA D MD
79863 CHANG, JAMES WOOJONG DO
79864 ASH-BERNAL, RACHEL MD
Georgia Composite Medical Board
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79865 HENDRIX, KRISTEN RENATA MD
79866 JAROSZ, TODD STEPHEN MD
79867 FISHER, STEPHEN MICHAEL MD
79868 ANAND, ANJOLI MD
79869 AUGUSTINE, NIDA RAUF DO
79870 BLACK, WHITNEY KAYLAN MD
79871 DAO, KIMBERLY MD
79872 DAWSON, VIRGINIA ROSE MD
79873 DOLBER, TRYGVE MD
79874 DREW, ALEXANDER MATTHEW DO
79875 FLYER, MARK MD
79876 CONKLIN, JOSEPH EARL JR MD
79877 JACKSON, GREGORY DWAIN MD
79878 GEGG, CHRISTOPHER ANTHONY MD
79879 PATEL, VATSAL MD
79880 PRYOR, KIMBERLEY DO
79881 SOERRIES, SCOTT MD
79882 TAMIRISA, KIRAN CHARY MD
79883 TANKO, QUENTIN MD
79884 THOMAS, ROBERT HENRY MD
79885 WHITAKER, APRIL MD
79886 YADAV, HEMANG MD
79887 ABDUL-HADI, OMAR MD
79888 BISHARAT, MOHANNAD MD
79889 DRUMMOND, HARRY MD
79890 DUCLOS, MARTIN ARTHUR MD
79891 BENS, SEBASTIAAN DO
79892 CARROLL, WILLIAM MD
79893 BAUTISTA, JOHN THEODORE MD
79894 NECKMAN, DAVID WADE MD
79895 PETERSON, JUSTIN WAYNE MD
79896 MARSCH, JEFFERY TROY MD
79897 NAYAK, VJAY MD
79898 MARBAS, LAURIE LADAWN MD
79899 MIRZA, IMRAN MD
79900 MITCHELL, JULIE DO
79901 LEWIS, CHANTAL MD
79902 KHALD, MUHAMMAD AZAM MD
79903 STERN, JOEL BENJAMIN MD
79904 SMITH, BLAKE ROBERT MD
79905 SMITH, CHRISTOPHER BLAKE MD
79906 STOUDENMIRE, CHARLES JACOB MD
79907 RICHARDSON, NICHOLAS SCOTT MD
79908 RAJENDRA, ANIL MD
Georgia Composite Medical Board
Minutes of the March 1 2018 Meeting
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79909 SAKR, MARK MD
79910 SAMALA, MALLIKARJUN MD
79911 SINCLAIR, ELIZABETH MIRIAM MD
79912 WHITE, STEPHEN MD
79913 WILSON, TRENTON MD
79914 TENG, STEPHANIE MD
79915 TRAN-NGUYEN, JACKLYN MD
79916 TRACY, BRETT MITCHELL MD
79917 JENNINGS, SARAH FOPPE MD
79918 KHALID, HEENA MD
79919 FINDEISS, LAURA MD
75720 HOFFMAN, DUSTIN CARL MD
79971 PATEL, SHIRISHKUMAR NARSINHBHAI MD
79972 POU, JASON DAVID MD
79973 RONEY, WESLEY BRIAN MD
79974 TAMIRISA, MITHILESH KUMARI MD
80021 MATA, MARIA MD
Reinstatements Approved:
11372 HITCH, WILLIAM STROUD MD
17011 SILVER, JEROME IRA MD
21741 MIKELL, JULIA LECRAW MD
24774 ALVARADO, CARLOS S MD
34760 ADAMS, JOHN BARNARD MD
38811 JACOBSON, WENDY NAN MD
38830 EPPELBAUM, LAWRENCE EDWARD MD
40952 MAJEED, KAZI IMRAN MD
45681 DURDEN, MARK DANIEL IV MD
46795 NUTT, RICHARD LEVERNE MD
48040 DOENLEN, HENRY ALEXANDER II MD
49728 DEPIPPO, PAUL ALEXANDER MD
49832 SIX, RICHARD R MD
54468 BULLINGTON, ANDREW BRANDON MD
57437 GOODWIN, ANIKA SARAN MD
58613 KIM, JIN DAE MD
62364 JACOBSON, MARTIN ALLEN MD
63458 MEEKINS MOORE, DIAHANN MARIE MD
64669 LIVIERATOS, SPEROS G MD
65137 LUFADEJU, ADETOYE MD
65148 MOTA-CASTILLO, MANUEL RAMON MD
67016 FOWLER, LINDSAY ELIZABETH DO
68241 MANDALAPU, KAMAL KISHORE MD
72054 LIIPFERT, RICHARD BURTON MD
73198 BADEL, SERGIO MD
Georgia Composite Medical Board
Minutes of the March 1 2018 Meeting
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73745 DANIEL, DEEPU DO
Dr. Gross motioned to go into closed session to discuss investigative matters. Dr. Robertson
seconded the motion and it carried unanimously
Dr. Deloach declared the meeting in open session.
NURSE PROTOCOL COMMITTEE
Dr. Callins presented the Nurse Protocol Committee report as a motion. The Board accepted the
report by unanimous vote.
The Board took the following actions:
Approved the following protocols under the provision of O.C.C.A. 43-34-25.
APRN Last APRN First Middle Supervising Physician Name
Acero-Smith Grace Elena Ralph Parks Warnock, MD
Adams Lauren James Sinclair, MD
Ali Natalie Joel Carpenter, MD
Andrews Mary Frances Jeffrey Sarata, DO
Archer Orchid Jocelyn Bayliss k. MD
Bachtel Mary Kathleen J Sharon Rasinovitz, MD
Baker Carol Dean Davidson Richard L. Elliott, MD
Battle Shomika Lasha Rodolfo B. Carrillo, MD
Beckles Saphia Reemon Bishara, MD
Belcher Robin Eric Lehman, DO
Belocura Edgardo Pableo Moyosore Suleiman, MD
Blanden Shekella Demetrice Robert David Campbell, MD
Boatright Howard Amber Brooke Shannon Ellis, DO
Boswell Tammi Joleen Dako, MD
Bowden Carrie Anne Jimmy D.Pruitt, MD.
Brainard Melanie Lynn Andrew Tucker, MD
Brinkley Valena Denise Michael Rogers, MD
Brown Rebecca Angeles Denise Thompson Cary Rose, MD
Brown Allyson Deanne Travis Jasper, MD
Brown Eric Jay Michael Ross, MD
Buchanan Kristie L. Sumandeep S. Sangha, MD
Burke Amber T. Josh Simmons, MD
Byrd DeAudrey Stokes Michelle Y. Evans, MD
Calabro-Payne Antonia Lyn Richard Tanner, DO
Cantrell Jennifer Suzanne Charlotte Williams Khan, MD
Carey James Azif Safarulla, MD
Cayado Michele A Ravindraprasad Shekarappa, MD
Georgia Composite Medical Board
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Cesar Chantal Robert K. Bond, MD
Chaney Dianna Nicole Charles Francois Cowart, MD
Chase Lana Marie Dominic E. Nkwocha, MD
Childers Shelly Stewart Amy K. Pearson, MD
Christina Merryman Michael B. Hocker, MD
Churbock Provins Cathleen Ann Melissa H. White, MD
Clark Robin Ann John J. White, MD
Cochran Christen Diane Sam Khair, MD
Conley Marla Cheryl Perkins, MD
Cooper N'Kema Jernee Ralph P. Warnock, MD
Corley Caitlin Michele Subhadra Shashidharan, MD
Cousin Carisalyn Nicole James M. Williams, MD
Cranston Catherine William Powell Jr. MD
Crawford Angela Nicole Ralph P. Warnnock, MD
Deguia Susan E. Ognjenka G. Vukotic-Brkic, MD
Denny-Smith Tammy Jane Srinivas Kolipaka, MD
Dixon Krystle Patricia F. Patterson, MD
Donaldson Yvonne Patrick Norvilus, MD
Doneski Christopher Steven C. Perlaky, MD
Downey Gloria Christoher Sarita Sharma, MD
Endsley Lynelle Bertram Prosser, MD
Estes Rachel Gatlin Muthusamy Sekar, MD
Etienne Josette Darrell Murray, MD
Ferrell Courtney Megan Staton Mark McKenna, MD
Forehand Brett Allen Kala K. Cunard, MD
Franklin Lori Anne Durwood Neal, MD
Furro Susan Ruth Montaivo, MD
Glaser Judy K. Joseph McEvoy, MD
Goniea Ashley Nicole Carlton Lancaster, MD
Green Amanda Joy Bharatkumar C. Patel, MD
Greene Priscilla Rowan Vincent G.Valencia, MD
Gregory Sarah Syed Agha, MD
Halder Michael Jeremy Nelson, MD
Hamilton Doreen Robert Collier, MD
Hand Kristi Allison Lauber, MD
Hand Kristi Lashun Allison Lauber, MD
Hanson Alexandra Tood Deavens, MD
Harvill Starr Dolapo Babalola, MD
Herron Lesia Divya Narayanaswamy, MD
Hill Erin Askew Charles Cowart, MD
Hogan Kara Krista J. Childress, MD
Georgia Composite Medical Board
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Hogan Kara Krista Jo Childress, MD
Howell Vanessa Raymond Easley, DO
Hughson-Chitolie Charisse Farhana Kaderin, MD
Hyers Heather Williams Michael A. Clark, MD
Iler Maria Sidhant Nagrani, MD
Jackson Harold Eugene Kimberly Harbin, MD
Jackson Savannah Bryanna Lindsey B. Roenigk, MD
Jackson Morgan Charlotte James Hunter Monroe, MD
Jasper Sherria Trenice Mazen A. Abdalla, MD
Jean-Louis Dora Demir Baykal, MD
Johnson Tamika Tamara Katherina Ekeji, MD
Jolly Tammy Michelle Madelaine Santo Vega, MD
Jones Dustin T. Richard J. Dowling, MD
Jones Rhonda Dee Toni Sylvester, MD
Jones Stephanie Hal Motlow Herd, MD
Jones Tracy Michelle Michael Unger, MD
Jordan Keri Cheryl Perkins, MD
Kandler Genevieve Matthew Whitley, MD
Kaniewski Cortney Morgan Ramanpreet Dhindsa, MD
Karr Nance Carol Nancy Q. LeFever, MD
Keen Ashley Paige Frank D. Jones, MD
King Tia Denae Lester A. Freeman, MD
Kinnett Marsha James Drury, MD
LaBella Virginia Calhoun Jerry Williams, MD
Lampkin Anndrea M. Chidinma D. Kabba, MD
Liang Katherine Michael E. Brown, MD
Liddell Jacquiece Kristi Kinsey Gotier, MD
Loepker Sarah Nicole Ali Araghi, MD
Long Ashley Maged Abdeimalik, MD
Manga Ebot Bi Virginia Joy Wight, MD
Mansfield Crystal A. Altee Johnson S.MD
Marcius Marva Monroe David M.Alvarez, MD
Marcius Marva Monroe Amr Agha, MD
McAdams Mary Kate William James Conkright, MD
McCormic Cory Lee Pankaj Agrawal, MD
McCriskin Samantha Dawn Robert Harris, MD
McIntyre Marcia Elesea Michael Metry, MD
Mendoza-Rodriguez Erika Sherri Barton, MD
Merritt Marcie LeAnn David L Day, DO
Midler Hillary Leah Lowman, MD
Miller Ashley Delene Roy C.Brownlow , MD
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Mitchell Roberta Stephen Anthony Messner, MD
Mobbs Mary Charlotte Khan, MD
Moore Martha M. Malini K. Reddy, MD
Morris Octavia Tommy Morgan, MD
NcNulty Amanda Rebecca Philip O'Connell, MD
Nelson Tricia Ezad Ahmad, MD
Newberry Brittany Jimmy Daniel Pruitt, MD
Norton Kathryn W. Modele O. Ogunniyi, MD
Norton Carol B. Valencia Burrus, MD
Nozile Petra Mitzi Rubin, MD
Ohanaja Pristella Ogechi Gloria Richards, MD
Pardue Paige Thomas Morianity, DO
Paris Kimberly Dawn James Graham, MD
Parker Dawn Michelle Ledford Gulshan Harjee, MD
Pearson Wendy C. Robert S.Cowles , MD
Pearson Jessica Michelle Timothy N. Udoji, MD
Peeples Corey D. Mark F.Corey, MD
Phelphs Ashley Lynn William Keeting, MD
Phillips Rachel Kate Karan Julka, MD
Powell Cynthia Leigh Marlene Zetzer Shivers, MD
Prather Kaley M. Bryan L. Woods, MD
Primas Brittanny Tanya Jones, MD
Puvis Debbie Lydia Tanner, MD
Radovich Haley Elizabeth Hatem Asad, MD
Randall Marjay Gladys Lawrence Reccoppa, MD
Ray Jacqueline M. Jeffrey Sarata, MD
Reed Melinda P. Tamara E.Sealy, MD
Reed Tracy Arnett Ziad Ahmad Ahmadie, MD
Reisen Amy Charlotte Grayson, MD
Richards Catherine Crenshaw John William Thornton III, MD
Rose Karen Alana Williams, MD
Rose Karen R Matin Abdul, MD
Salley Audrey E. Robert S. Cowles, MD
Samples Lisa Ashley Nicole Davidson, MD
Sanders Diana David P Fieseler, MD
Seabrooks Sharika Shenika Steven Lee Morganstern, MD
Seitz Roslyn Marie Matthew Taylor Keadey, MD
Sherman Carmen Judy Rita Deattrea Beckford, MD
Sikes Devan Sandra Gibbs, MD
Simokaitis Sabrina Ferrol A. Sams III, MD.
Skinner Robbie Leah Himanshu Mukesh Patel, MD
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Skipper Dalton James James Rogan, MD
Soto Gina William Benedict, MD
Sparks Lakeisha Ian Davis, DO
Stallings Judith A. Hans Lee, MD
Stephanopoulos Irene Glenis Craig Heigerick, DO
Stephens Tammy Lenora Allen, MD
Steves Amy B. Kara Prickett, MD
Stewart Deborah Margaret David Samuels, DO
Stoyle Sheryl Angel Arthur Yancy ll , MD
Stoyle Sheryl A. Eric M. Lehman, MD
Taylor Sebrina Guy Y. Augustin, MD
Thomas Cassandra Crystal Owens, MD
Thompson Taylor Victoria Roshan George, MD
Tran Tammy Tu Zavier C. Ash, MD
Trivedi Tran B Vera Reaves, MD
Ulbricht Lisa Price Nathan Michael Polite, MD
Van Ness Kimberly Megan Deborah Bates, MD
Wade Nathan Charles Craig Byron Colby, MD
Webb Erica Williams Nailah Abdulbaagee, MD
Welford Colleen A. Robert F.Dollinger, MD
White Dianna Lynn Melissa D. Primrose, MD
Wilder Janice M Dawn Wilson, MD
Williams Tammie A. Bert P. Wall, MD
Williams Whitney N. John Fuller Mynatt Jr. MD
Willis Kristen Alexis Hicham Churbaji, MD
Wilson Catherine Marie Melissa Denise Primrose, MD
Wood Amy Lance Slade, MD
Wright Brooke Blackwell John Aicher, MD
Yoo Jiwon James Y. Lee, DO.
Young Caitlin Crowe Dolores Haviland-Foley, MD
Young Angelique Antony Labady, MD
Determined that the following protocol agreements meet the provisions of O.C.G.A. 43-34-25
with changes.
APRN Supervising Physician
1. Abt, Ashley Mark A. Lee, MD
2. Awwah, Diana Richard G. Spurlock, Jr., MD
3. Ayer, Adam Krista Childress, MD
4. Barker, Lauren Ron Alleyne, MD
5. Beckles, Saphia Reemon Bishara, MD
6. Bell, Katrina Padmashree Woodham, MD
7. Broussard, Jennifer Canady Sheryl, MD
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8. Burnham, Cynthia Roberts, Benjamin, MD
9. Dawner, Charmaine Alexander Osowa, MD
10. East, Angela Childress, Krista, MD
11. Genevieve, Kandler Mathew Whitley, MD
12. Harvey, Heather Navin Patel, MD
13. Hoffman, Judy Maybury, Alexander, MD
14. Hovan, Katelyn David Ecklund, MD
15. Iler, Marie Walker-Blake, Tameka, MD
16. Jones, Stephanie Herd, Hal, MD
17. Johnson, Ryan David Campbell, MD
18. Krawczyk, Whitney Levy, Jonathan, MD
19. Seitz, Roslyn Mattew Keadey, MD
20. Simmons, Nicole Brandi Warren, MD
21. Tesfaye, Woinshet Dolapo Babalola, MD
22. Primas, Brittany Tonya Jones, MD
23. Mitchell, Roberta Stephen Messner, MD
24. Norton, Carol Valencia Burrus, MD
Other Business:
1. Board discussed a request whether an APRN can remove in-grown toenails based on
experience and taining.
2. Board requested the staff to contact the South Carolina Board, to obtain information on
how they handle APRN practice and telemedicine.
PHYSICIAN ASSISTANT COMMITTEE
Dr. Antalis presented the Physician Assistant Committee report as a motion. The Board accepted
the report as amended by unanimous vote.
The Board took the following actions:
Approved the following applications for initial licensure with a supervising physician:
PA Supervising Physician
Adams, Emma Gee, John
Anderson, Katherine Payne, Diane
Birth, Synquincity Jones-Taylor, Cedrella
Bowers, Amanda Merritt, James
Brack, Chelsey Hoodbhoy, Nadeem
Brehob, Christina Chronos, Nicholas
Brown, Jamar Traub, Jeff
Dichiera, Robert Cook, Jay
Gaston, Anne Jones, John
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Gatlin, Lawson Chebuhar, Craig
Holl, Nicholas Lafosse, Vera
Hublikar, Swaraj Harrison, Jason
Hurst, Alexandra Daniels, Lisa
Kazinec, Joel Kayal, John
Louvin, Kelly Erinle, Akinwande
Momin, Anikraza Nelson, Jeremy
Murphy, Cassidy Alkhatib, Mhd Anas
O'Donnell, Jennifer Ashby, Talitha
Reichman, Daniel McMillen, James
Rodriguez, Alfred Gluzman, Alexander
Romeyn, Leslie Sayeed, Shariq
Rush, Yvonne Jones-Taylor, Cedrella
Schweikarth, Lindsay Rayappa, Steven
Taub, Sarah Wilkes, Joseph
Waters, Jessica Goel, Anuj
White, Sheena Sells, Deneta
Young, Brittany Szabo, Stephen
Approved the following applications for initial licensure without a supervising physician
PA
Alvarez-Forte, Igor
Bicher, Jordan
Edwards, Roxanne
Grammes, Lindsay
McKinnon, Meagan
McKown, Brian
Medved, Anne
Mustafa, Malaka
Pandya, Neerali
Pitts, Johnny
Poindexer, Katherine
Vargas-Vera, Sarai
Approved application for reinstatement with a supervising physician:
PA Supervising Physician
Bell, Rebecca Fareed, Ayman
Approved application for reinstatement without a supervising physician:
PA
Miechiels, Kimberly
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Approved the following application for reinstatement with a supervising physician pending
additional information:
PA Supervising Physician
Ward, Miranda Tobin, Joseph
Approved the following application for reinstatement with a supervising physician with a NON-
Disciplinary Private consent order and $500 fine for unlicensed practice:
PA
A.L.
Approved Add/Change applications:
PA Supervising Physician
Ali, Anisa Merchant, Riddhi
Anderson, Adrienne Watts, Ronald
Askew, Esther Heindel, N Hadley
Brooks, Haidy Barton, Sherri
Busch, Mitchell Baker, Donald
Cassidy-McKinney, Kerri Strother, Reginald
Chambers, Kelli Flandry, Frederick
Coderellis, Simone Johnson, James
Cottrell, Morgan Olliff, Stacy
Couey, Christopher Reddy, Ram
Cox, Allison Griffith, Timothy
Cox, Shannon Odjegba, Ochuko
D'Angelo, Maria Tafor, Stephen
Davis, Kelsey Hall, Heather
DeGraw, Katy Self, Thomas
Deviese, Rachael Johnson, Scott
Dexter, Kathy Vandemark, Wendy
Dinh, Elizabeth Boudreaux, Margaret
Dixon, Tamika Lynde, Grant
Duvall, Chelsea Lee, Charles
Edwards, Marshall Carrington, Helen
Edwards, Marshall Darji, Jaykrishna
Elswick, Emily Storey, Suzanne
Everidge, Angel Elkin, Gary
Fowler, Mandi Wieskopf, Bram
Fowler, Timothy Lee, Mark
Fowler, Timothy Brand, David
Freelen, Chris Siegelman, Jeffrey
Galon, Gabrielle Goss, Jennifer
Green, Sonya Grossman, Ilene
Harris, Blair Jain, Pravin
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Henderson, Brittney Burkmar, Jennifer
Hutchins, James Glick, Wesley
James, Alexandra Rendon-Garcia, Jose
Jenkins, Patrick Gallo, Dominic
Johnson, Cheri Singhal, Sunit
Johnson, Justin Nettey, Ronald
Jones, Stacia Tobin, Joseph
Khan, Reja Olliff, Stacy
Kimsey, Elicia Andrews, Amana
Klein, Susan Vandemark, Wendy
Lindsay, Renee Roberts, Donna
Luong, Phuong Bynum, Aliya
Lvovich, Vadim Narayan, Preeti
Mansoori, Anissa Taliaferro, Sumayah
Marcellino, Jennifer Findley, Ambrous
Martin, Tamara Munireddy, Sanjay
McGraw, James Federico, Thomas
Megay, Abigail Portzer, James
Mehta, Meena Helfman, Steven
Morrison, Linda Levy, Jason
Neill, John Hajo, Nawar
Nguyen, Khang Polk, Reynaldo
Nieves, Jessica Pandya, Rajiv
Nolen, Johnathon Morrison, Douglas
Noon, Alan Moody, Raymond
Ordonez-Fall, Katherine Cangiano, Jose
Owens, Erin Holladay, David
Pandya, Kalyani Brady, Colin
Pankowski, Laura Erens, Greg
Patton, Michael Morgan, Joe
Rama, Nisha Roth, Jeffrey
Reeves, Lasonja Vallabhaneni, Akhil
Reeves, Millie Alston, Mary
Rose, Kayla Rose, Cary
Rote, Rebecca Brosnahan, David
Sanders, Deanna Bowman, Robert
Schumacher, John Davtyan, Hakob
Sears, Shelley Lipscomb, Michael
Singh, Amanda El-Deiry, Mark
Smith, Carley Feliciano Aponte, Alexandra
Smith, Jawauna Rizvi, Syed
Snyder, Melody Burch, Jason
Stephens, Andrew Byrne, John
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Stone, Dawn Gedrick, Brooke
Tolbert, Renarda Occhipinti, Marcus
Tran, Quynh Bechara, Rabih
Tsonas, Alana Jackson, Leopold
Turk, Kendyl Whisenhunt, Anumeha
Turner, Moniqua Greene-Harris, Sandea
Von Der Schulenburg, Amanda Hanafi, Magdi
Ward, Cody Coe, Stanley
Watkins, Angela Jacobs, William
Williams, Michelle Frinks, Terence
Williamson, Melissa Brosnahan, David
Willingham, Justin Thompson, Byron
Wilson, Jerry Cole, Tonya
Won, Chongmyong Talley, Roy
Zimmermann, Katherine Schwock, Kathy
Approved the following Additional Duties Request:
Mollie Heimerich PA-C—with Dr. Rita Mezzatesta
Peripheral Joint Injections (to Knee Only)
Ashley Fullerton PA-C—with Dr. Michael Bosley
Dialysis Catheter Insertion
Port Placement
Bone Marrow Biopsy
Intrathecal Injection
Annsley Matthews PA-C—with Dr. Jeffrey Silveira
Nasopharyngoscopy (Order, Perform, and Interpret)
Victoria Suttles PA-C—with Dr. Jeffrey Silveira
Nasopharyngoscopy (Order, Perform, and Interpret)
Lacey Wood PA-C—with Dr. Raven Elosiebo-Walker
Micro-Needling Rejuvapen
Ultherapy
Clayton Young PA-C—with Dr. Marcus Brown
Stress Testing Supervision
Informed applicant that this is not an Additional Duty:
Rebecca Bell PA-C—with Dr. Ayman Fareed
Full Psychiatric Evaluation Follow up
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Invite for an Interview:
J.V.
Other Business:
1. Questions - What facilities in the state of Georgia are considered fee exempt? Board
replied On the Initial and Reinstatement Physician Assistant application, questions
seventeen (17) and eighteen (18) are to be updated as follows:
17. Are you an employee of the state of Georgia?
18. Are you an employee of a county government of the state of Georgia?
On the Physician Assistant application to add/change supervising physician,
questions fourteen (14) and fifteen (15) are to be updated as follows:
14. Are you an employee of the state of Georgia?
15. Are you an employee of a county government of the state of Georgia?
2. Ruth Whitaker: Does the physician have to co-sign all H&P and Discharge summaries
for a PA? Board replied no, refer to the GCMB Rules and Laws and to the hospital’s
bylaws and/or policies.
3. Judy Cooper: Inquiry of applying for licensure without references, because she has never
worked as a physician assistant. Board approved for Interim Executive Director to send a
letter.
4. Approved PA Advisory Committee request to update the Reference Form C/D, to change
question three (3) to the following: Date and duration, you worked as precepted with
candidate
RESPIRATORY CARE COMMITTEE Dr. Collins presented the Respiratory Care Committee report as a motion. The Board accepted
the report by unanimous vote.
The Board took the following actions:
.
Approved Reinstatement Applications:
Holton, Brittani- pending additional information
Pumphrey, Amy- pending additional information
Approved Reciprocity Applications:
Alexander, Raoul
Davis, Deadria
Funderburk, Kristina
Jackson, Kimoy
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Mann, Misty
Polka, Chelsea- pending additional information
Schmitz, Brooke- pending additional information
Sewell, Shannon
Approved Temporary Permits:
Abebe, Agernash
Assefa, Aster
Awoniyi, Felicia
Bourava, Anastasia
Hardy, Anita
Holloway, Roshawnda
Johnson, Shawndra
Kebede, Hiwot
Middleton, Tanzineka
Okeke, Kosi
Park, Minhee
Ramsey, Saundra
Sahle, Zetseat
St. Jean, Christina
Shelangi, Serena
Approved Administrative Upgrades;
Adinaro, Margaret
Adzer, Mimido
Brock, Taylor
Dahal, Radha
Ellis, Victoria
Fadili, Maria
Jackson, Elliot
Johnson, Taylor
Lee, Samuel
Miller, Felisha
Overstreet, Larisha
Ramos, Natalie
Waters, LaDundra
Other Business:
1. Reviewed Rule 360-13-01 “Requirements for Board Certification” and referred to the
Rules Committee for posting.
ACUPUNCTURIST COMMITTEE
Dr. Downey presented the Acupuncturist Committee report to the Board as a motion. The Board
accepted the report by unanimous vote.
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The Board took the following actions:
Approved Quarterly Report of Limited License:
Gina Michaels
Approved Application for Initial Licensing:
Kenneth Huynh - Tabled pending additional information
Sungtaek Kang
Other Business:
1. Eunha Cho: - Schedule interview for a position on the Acupuncture Committee.
2. Mark Schwartz: Georgia Association of Acupuncture and Asian Medicine
Augusta University attended the meeting by teleconference offering with information
Doctorate in Physical Therapy and Acupuncture
PERFUSION COMMITTEE
Dr. Retterbush presented the Perfusionist Committee report as amended. The Board accepted the
report by unanimous vote.
The Board took the following actions:
Approved Application for Initial Licensure:
Patrick Davis
PAIN MANAGEMENT CLINIC COMMITTEE
Dr. Downey presented the Pain Management Clinic Committee report as a motion. The motion
was seconded by Dr. Marshall. The Board accepted the report by unanimous vote.
The Board took the following actions:
Approved initial applications:
File # Pain Clinic Name
455 Interventional Pain and Wellness - LaGrange
456 Interventional Pain and Wellness - Americus
457 Back to Life Pain Center
Ratified administratively approved applications:
License # Pain Clinic Name
142, 147, Ancora Pain Recovery
Add Physician Assistant Kerri Cassidy-McKinney
371, 431 Ancora Pain Recovery
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Add Practicing Physician William Hammonds
371 Ancora Pain Recovery
Delete Practicing Physician Van Malia
381 Ancora Pain Recovery
Add APRN Princess Clark
159 Commerce Pain Management
Add APRN Kareen Carty-Davy
149, 374, 437, 439 Hemlock Pain Center
Add practicing physician Jerry Spivey
149, 374, 437, 439 Hemlock Pain Center
Add physician assistant Maria D’Angelo
Delete APRN Dwayne Taylor
153 Pain Management & Wellness Centers of GA
Add practicing physician Belinda Millington, MD
225, 226, 227 Pain Management Specialists of Atlanta
Add practicing physician Dominic Seymour
Other Business:
1. Board requested the committee to review the 2008 Georgia Board’s Guidelines for the
use of Controlled Substance for the treatment of pain Policy, and bring it up to date,
given the current opioid environment. The committee had proposed adopting the 2017
FSMB opioid guidelines, they received positive feedback from Georgia pain groups in
favor of that proposal. However, recently the Board has been made aware that the FSMB
is considering modifying their guidelines. Therefore, the Board has chosen to table the
idea of adopting the FSMB guideline, until they see the revisions.
COSMETIC LASER PRACTITIONER COMMITTEE
Dr. Gross presented the Cosmetic Laser Practitioner Committee report as a motion. The Board
accepted the report by unanimous vote.
The Board took the following actions:
Approved Assistant Cosmetic Laser Licensure Applications:
Liliya Feldman
Emily Raville
Lauren Siso
Donna Stiles – pending additional information.
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LaTesha Sylva
Blakley White
Approved Senior Cosmetic Laser Licensure Applications:
Kayla Hopkins
Mary Overby
Nancy Reddington
Other Business:
1. Approved for licensure with Non Disciplinary Consent Order.
A.G
A.M.
2. M.B. Tabled for additional information.
RULES COMMITTEE
Dr. Gross presented the Rules Committee report as a motion. The Board accepted the report by
unanimous vote.
Rule Posting
Motion Dr. DeLoach seconded Dr. Retterbush and motion carried to refer the following Rule to
the Office of the Attorney General for review before posting for comment:
1. Rule 360-13-.01 “Requirement for Board Certification”
2. Rule 360-3-.02 “Unprofessional Conduct. Defined.”
3. Rule 360-15-.01 “Requirement for Physicians.”
Board approved an additional question to the FAQs
4. Rule 360-3-.07 “Practice Through Electronic or Other Such Means.”
Tabled a decision on the Rule, and will review the proposed changes at the next meeting.
Dr. Retterbush motioned to go in closed session to discuss confidential enforcement and
investigative matters. Dr. Marshall seconded the motion and it carried unanimously.
Dr. DeLoach declared open session.
ATTORNEY GENERAL (AG) LEGAL ENFORCEMENT ACTION REPORT (LEAR)
Mr. Reimers presented the AG /LEAR report, .Dr. Marshall submitted a motion, seconded by
Dr. Marshall to accept the report. The motion carried unanimously.
1. 20160273: Release files
2. Christian Kaufman MD: Accept Inactive Status
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3. 20170406: Deny request
4. Harvey Leslie, MD: Deny request
5. Weston Welker, MD: Accept Inactive Status
6. 20170422: Table
7. 20151311: Close
8. Soren Thomas, MD: Table
9. Mark Durden, MD: Accept the Public Consent Order for licensure
10. Lawrence Eppelbaum, MD: Accept Public Consent Agreement for Reinstatement
11. 20150699: Approved terms of Public Consent Order
12. Peter Ulbrich, MD: OSAH decision for Suspension
13. Brandon Hicks, MD: Accept Public Consent Order for Indefinite Suspension
14. 20150931: Close
15. 20181415: Referred to AG-Summary Suspension
WELLNESS COMMITTEE
Dr. Collins presented the Wellness Committee report. The Board accepted the report by
unanimous vote.
The Board took the following actions:
1.
2. PHP report by Dr. Paul Earley and Robin McCown.
3. 20161818 - Granted approval to return to practice.
4. 20161327 – Order
5. 20070278 – Table
6. CC – Table
7. SF – Table
8. 20161410 – Table
9. 20160222– Grant extension
10. 20171579 – Approve doctor.
INVESTIGATIVE INTERVIEW REPORT
David Retterbush, M.D. presented the Investigative Interview report as a motion, and was
seconded by John Antalis, M.D. The Board accepted the report by unanimous vote. The Board
took the following actions.
20170116 Peer Review 20170157 Close
20170308 Forward to Investigations 20170434 Close with letter of Concern
20170447 Close 20170553 Close
20170969 Close 20172034 Close with Letter of Concern
20172212 Close 20172295 Close
20172351 Close with Letter of Concern 20172371 Close
20180070 Refer to AG for Notice of Hearing
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INVESTIGATIVE COMMITTEE
The Investigative Committee report was presented as a motion by David Retterbush, M.D, and
was seconded by J. Jeffery Marshall, M.D. The Board accepted the report by unanimous vote.
The Board took the following actions.
Close:
20140113 20150575 20150576 20151201 20151318 20160111
20160853 20160884 20160911 20161057 20161102 20161769
20161775 20161911 20162263 20162293 20162401 20162471
20170278 20170328 20170475 20170505 20170838 20171289
20171438 20171517 20171615 20171642 20171643 20171754
20171762 20171794 20171832 20171895 20172100 20172155
20172166 20172170 20172290 20172333 20172348 20172349
20172350 20172381 20180003 20180040 20180079 20180084
20180085 20180089 20180096 20180120 20180127 20180148
20180156 20180222 20180267 20180275 20180301 20180304
20180383 20180384 20180386 20180388 20180403 20180426
20180442 20180460 20180461 20180488 20180489 20180510
20180511 20180525 20180538 20180540 20180544 20180545
20180551 20180564 20180594 20180595 20180597 20180599
20180602 20180614 20180617 20180623 20180631 20180632
20180634 20180637 20180644 20180645 20180646 20180651
20180657 20180659 20180667 20180673 20180684 20180687
20180696 20180697 20180699 20180703 20180709 20180712
20180718 20180726 20180732 20180737 20180739 20180763
20180768 20180776 20180781 20180798 20180799 20180820
20180882 20180913 20180961 20181040 20181050 20181174
20181192
Close with Letter of Concern:
20151145 20172005 20172136 20172139 20172152 20180159
20180164 20180260 20180437 20180622 20180738 20180753
20180835
Invite for Investigative Interview:
20162201 20162379 20170037 20171324 20171385 20171970
20172038 20180219 20180220 20180253 20180294 20180385
20180653
Further Investigation:
20160910 20161228 20170448 20180256 20180807
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Table
20160648 20160665 20171581 20171790 20180001 20180479
20180678 20180679 20180686
Mirror Action from Other State:
20161672
Attorney General’s Office:
20151275 20162265 20170108 20170179 20170856 20181156
Peer Review:
20121568 20180189
EXECUTIVE SESSION
Dr. Marshall motioned to go into executive session. Dr. Antalis seconded the motion and it
carried unanimously to discuss personal actions.
Dr. Deloach declared open session.
There being no other business, Dr. Marshall submitted a motion, seconded by Dr. Antalis, to
adjourn the meeting. The motion carried unanimously. Dr. DeLoach adjourned the March 1,
2018 meeting at 6:30 PM
__________________________________ _____________________________________
E. Daniel DeLoach, MD LaSharn Hughes, MBA
Chairperson Interim Executive Director
__________________________
Recorded by Diane Atkinson
.