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Practitioner Application

Please send me a practitioner application for Health Partners:
Please take a moment to complete the form below.
Required fields are marked with an asterisk (*).
* Last Name:
* First Name:
* Degree:
* Specialty:
* Group Name:
* Mailing Address:
* City:
* State:
* Zip:
* Contact Person:
* Contact Number:
* Email Address:

*  All items must be filled in before your request will be processed.
Thank you for your interest in the Health Partners Network!

Health Partners now accepts the Georgia Uniform Application.  Please choose links below to download the application (Part I & II).

Georgia Uniform Application Part I

Georgia Uniform Application Part II

We request that you also fill out the information above so that supporting documents can be mailed to you. 

If you have any questions, or would like to know more about the credentialing process, please contact the Credentialing Coordinator at 770-219-6602. You should receive the supporting documents within 5 days of your request.

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