We are very excited of the opportunity to have you as a part of our team via contract. This juncture will be both fulfilling and challenging.  Here are the requirements:

  • Credentials
    • Agreement (Provided via email)
    • W9 form (Provided via email)
    • Copy of CV(s)
    • Copy of medical license(s)
    • NPI number(s) (for billing purposes if applicable)
    • COI - Copy of professional liability coverage & Workers Comp (Certificate of Insurance listing GDS as the certificate holder – this is not a request to be added as an additional insured but allows us to be notified in case of cancellations)
    • Copy of your protocol for our technicians (if applicable)
    • General Safety Rules (Provided via email)
    • Background Authorization (Provided via email)
    • Copy of National Practitioner Data Bank Self-Query (you provide)
    • HIPAA Compliance Agreement (Provided via email)
  • Available Locations
    • Alto, GA
    •  Forest Park,GA
    •  Glennville,GA
    • Leesburg, GA
    • Macon, GA
    • Paulding,GA
    • Seminole, GA
    • Washington, GA  

Please provide the information above to 678-750-1601(fax).  We look forward to beginning the process!


Respectfully yours,

GDS

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