Change My Name or Address
Change Address:
To change your address online, please click here to log on and complete your request.
NOTE: Under normal circumstances the practice location address is posted on our website for public access and the mailing address is for GCMB correspondence purposes unless there is only one address on file. Therefore, please state whether the new address is the mailing/home address or your practice location address.
Name Change:
You must provide previous name, as well as name change information. A copy of any and all legal documents such as marriage license, divorce decree or legal name change certificate. Please mail, fax, or email scanned documents along with your signed written request to the contact information provided below:
Please include a telephone number and/or email address so we may contact you with any question we may have.
Robert Jeffery, Director of Operations
Fax to: (404) 656-9723
Email to: rjeffery@dch.ga.gov
ATTENTION: DO YOU ALSO WANT A NEW WALLET ID CARD?
Please be aware that we will not automatically issue you a new wallet ID card with your address and/or name change. You may request a replacement ID card online with your updated address request. Click here to request the DUPLICATE ID CARD online. If you are requesting a name change and would like to order a new wallet ID card, please include a $10 check or money order made payable to "Georgia Medical Board" along with your name change request and mail to Robert Jeffery at the address list above.
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