GEORGIA COMPOSITE MEDICAL BOARD · Georgia Composite Medical Board from July 2, ... Wallace and seconded by Ms ... Ms. Wray updated the Board on the status of matter that have been

GEORGIA COMPOSITE MEDICAL BOARD

MINUTES

JUNE 9, 2016

1

The Georgia Composite Medical Board (GCMB) held its regular meeting on June 9, 2016 at 2 Peachtree

St., NW 36th Floor, Atlanta, GA 30303 to consider Medical Board matters.

Board members present:

Alice A. House, MD, FAAFP, Chair

John S. Antalis, MD, Vice Chair

Keisha Callins, MD, MPH

E. Daniel DeLoach, MD

John Downey, DO

Charmaine Faucher, PA-C (ex-officio)

Alexander S. Gross, MD

J. Jeffrey Marshall, MD

Jane “Cami” McGarity

B. K. Mohan, MD

George “Trey” Powell, MD

Joe Sam Robinson, MD

Ronald “Ronnie” Wallace, MBA

Charles White, DO

Board members absent:

David Retterbush, MD

Richard Weil, MD

Management and legal staff present:

Robert Jeffery, MBA, Executive Director

Edwin Slappey, MD, Medical Director

Janet Wray, Senior Assistant Attorney General

David Stubins, Senior Assistant Attorney General

Carl Bedingfield, MD, Assistant Medical Director

Betsy Cohen, Staff Attorney

Carol Dorsey, Licensure Unit Manager

Daniel Dorsey, Operations Unit Manager

Karl Reimers, Investigations Unit Manager

Patricia Sherman, Enforcement Unit Manager

Phyllis White, Director of Special Projects

CALL TO ORDER

Dr. House called the meeting of the Georgia Composite Medical Board to order at 7:30 a.m.

AGENDA AND MINUTES

Dr. Gross submitted a motion, seconded by Dr. Robinson, to approve the agenda of the June 9, 2016

meeting. The motion carried unanimously.

Dr. Gross submitted a motion, seconded by Dr. White, to approve the minutes of the May 5, 2016


Dr. Gross submitted a motion, seconded by Dr. White, to approve the minutes of the June 6, 2016


Dr. Gross submitted a motion, seconded by Dr. DeLoach, to amend the minutes of the June 4, 2015

meeting to correct a spelling error on page 4. The motion carried unanimously.

Dr. Gross submitted a motion, seconded by Dr. DeLoach, to amend the minutes of the January 7, 2016

meeting to reflect the appointment of Jennifer Bass to the position of Deputy Executive Director. The

motion carried unanimously.

Dr. Gross submitted a motion, seconded by Dr. DeLoach, to amend the minutes of the March 3, 2016

meeting to reflect the appointment of Robert Jeffery to the position of Executive Director. The motion

carried unanimously.


MINUTES

JUNE 9, 2016

2

CHAIRPERSON’S REPORT Dr. House presented the following items in her report:

Presented a certificate issued by Secretary of State Brian Kemp proclaiming Ms. McGarity an

outstanding citizen of Georgia.

Presented a certificate issued by Secretary of State Brian Kemp proclaiming Dr. Powell an


Presented a certificate issued by Secretary of State Brian Kemp proclaiming Dr. White an


The Board took the following actions:

1. Thanked Ms. McGarity for her faithful service to the people of Georgia as a member of the

Georgia Composite Medical Board from July 2, 2012 through July 1, 2016.

2. Thanked Dr. Powell for his faithful service to the people of Georgia as a member of the Georgia

Composite Medical Board from August 15, 2012 through July 1, 2016.

3. Thanked Dr. White for his faithful service to the people of Georgia as a member of the Georgia

Composite Medical Board from May 11, 2007 through July 1, 2016.

EXECUTIVE DIRECTOR’S REPORT Mr. Jeffery presented the following items in his report:

Correspondence from Laura Tao, QT Medical, asking whether or not an out-of-state physician’

reading of results from an electrocardiogram (ECG) device would fall under the Board’s

jurisdiction.

A discussion draft of a document codifying the manner of nominations, elections, and duties of

the Chairperson and Vice Chairperson.

Information and discussion from Dr. Gross concerning model legislation to permit out-of-state

sports teams’ physicians to engage in the treatment of injured athletes during their sporting events

in Georgia.

A proposed rule by the US Department of Veterans Affairs to grant full practice authority to

APRNs.

A May 2016 Medscape article ranking Georgia the 11th-best place to practice medicine, and

naming Johns Creek as a recommended city in Georgia.

A May 2016 Wall Street Journal article discussing a study of telemedicine that found that the

incidence of misdiagnoses of skin problems was unsettlingly high.

Correspondence from Andrew L. Turnage, M.Ed., executive director of the Georgia State Board

of Cosmetology and Barbers, asking whether ultrasound cavitation is regulated by the Georgia

Composite Medical Board.


1. Referred Ms. Tao to the laws and rules governing telemedicine in Georgia, particularly O.C.G.A.

43-34-31.

2. Assigned the Rules Committee the task of reviewing the issue of codifying the manner of

nominations, elections, and duties of the Chairperson and Vice Chairperson.

3. Tabled the item concerning model legislation to permit out-of-state sports teams’ physicians to

treat injured athletes in Georgia, and asked Dr. Gross to provide more information.

4. Asked Dr. DeLoach to develop a resolution concerning the proposed Veterans Affairs rule.


MINUTES

JUNE 9, 2016

3

5. Asked Mr. Jeffery to inform Mr. Turnage that ultrasound cavitation is the practice of medicine,

and therefore falls under the Board’s jurisdiction.

RULES HEARING

Dr. Gross convened the public hearing concerning the following proposed Rules amendments:

Rule 360-8-.06: “Renewals and Continuing Education.”

Dr. Gross asked if anyone was present to address the Board on the posted Rule amendments. No was

present to address the Board.

Dr. Gross made a motion to amend Rule 360-8-.06 “Renewals and Continuing Education.”

that the Board find the formulation and adoption of these rules do not impose excessive regulatory cost on

any licensee and any cost to comply with the rule cannot be reduced by a less expensive alternative that

fully accomplishes the objectives of the applicable laws; that the Board finds that it is not legal or feasible

to meet the objectives of the applicable laws to adopt or implement differing actions for businesses as

listed in O.C.G.A. 50-13-4(A) (3)(A),(B),(C), and (D).

Rule 360-14-.06: Exceptions to Disclosure and Consent Requirements

Dr. Gross asked if anyone was present to address the Board on the posted Rule amendments. No was


Dr. Gross made a motion to amend Rule Rule 360-14-.06: “Exceptions to Disclosure and Consent

Requirements” that the Board find the formulation and adoption of these rules do not impose excessive

regulatory cost on any licensee and any cost to comply with the rule cannot be reduced by a less

expensive alternative that fully accomplishes the objectives of the applicable laws; that the Board finds

that it is not legal or feasible to meet the objectives of the applicable laws to adopt or implement differing

actions for businesses as listed in O.C.G.A. 50-13-4(A) (3)(A),(B),(C), and (D).

Dr. Gross made a motion to amend Rule 360-31-.13: Composition and Responsibilities of the Orthotist &

Prosthetist Advisory Committee. Dr. Gross asked if anyone was present to address the Board on the posted Rule amendments. No was


Dr. Gross made a motion to amend Rule 360-31-.13: “Composition and Responsibilities of the Orthotist &

Prosthetist Advisory Committee” that the Board find the formulation and adoption of these rules do not

impose excessive regulatory cost on any licensee and any cost to comply with the rule cannot be reduced

by a less expensive alternative that fully accomplishes the objectives of the applicable laws; that the

Board finds that it is not legal or feasible to meet the objectives of the applicable laws to adopt or

implement differing actions for businesses as listed in O.C.G.A. 50-13-4(A) (3)(A),(B),(C), and (D).

Dr. Deloach seconded the motion, and it carried unanimously.

EXECUTIVE SESSION Mr. Wallace submitted a motion, seconded by Dr. White, to go into executive session to discuss

investigative matters. Dr. House declared the meeting in executive session. Upon conclusion of the

Board’s discussion of confidential matters, Dr. House declared the meeting in open session.


MINUTES

JUNE 9, 2016

4

LEGAL / ENFORCEMENT ACTION REPORT

Ms. Cohen presented the Legal / Enforcement Action Report. Dr. Gross submitted a motion, seconded by

Dr. White, to accept the report. The motion carried unanimously.


1. SHAH, CHANDRESH BHAUVAT, MD (physician license # 38955): Terminated probation.

2. HEGWOOD, TEKI SUSAN, MD (physician license # 64386): Upon a motion submitted by Dr.

Gross and seconded by Dr. DeLoach, approved a public consent order based on disciplinary

action taken by the Medical Board of California and the Medical Licensure Commission of

Alabama.

3. COHEN, LISA MICHELE, MD (physician license # 62959): Upon a motion submitted by Dr.

Gross and seconded by Mr. Wallace, approved a public consent order based on disciplinary action

taken by the Massachusetts Board of Registration in Medicine, the Medical Board of California,

and the Illinois Division of Professional Regulation.

4. THOMAS, SOREN S., MD (physician license # 26895): Upon a motion submitted by Dr. Gross

and seconded by Dr. Powell, identified an acceptable training program that would comply with

the terms of a public consent order issued October 9, 2014.

5. CASE # 2015-0856: Upon a motion submitted by Dr. Gross and seconded by Dr. Powell,

approved a particular course and training program that would comply with the terms of a private

consent order issued May 5, 2016.

6. CASE # 2016-0049: Upon a motion submitted by Dr. Gross and seconded by Dr. DeLoach,

referred the matter to the Attorney General for summary suspension.

7. CASE # 2016-0622: Issued a letter of concern and closed the case.

8. CASE # 2010-0015: Closed the case.

9. CASE # 2010-0931: Closed the case.

10. CASE # 2010-1369: Closed the case

11. Y.N.: Allowed the Attorney General’s Special Prosecutions Unit access to requested application

and enforcement files.

12. CASE # 2013-0713: Upon a motion submitted by Ms. McGarity and seconded by Dr. DeLoach,

accepted a request for inactive status and closed the case.

13. WINDSOR, ROBERT EARL, MD (license # 31857): Upon a motion submitted by Dr. Gross and

seconded by Mr. Wallace, approved an interim public consent order suspending the license until

the resolution of the pending criminal charges.

14. R.R.: Released information to the US Drug Enforcement Agency in response to a subpoena.

15. POTTS, FRED ERNEST IV, MD (license # 75324): Denied a request to lift prescribing

restrictions specified in a January 7, 2016 public consent order.

16. G.C.: Released information demanded by a Federal Grand Jury subpoena.

17. GOWDER, GEORGE DAVID III, MD (license # 25163): Upon a motion submitted by Mr.

Wallace and seconded by Ms. McGarity, approved an interim public consent order suspending

the license until the resolution of the pending criminal charges.

ATTORNEY GENERAL’S REPORT

Ms. Wray updated the Board on the status of matter that have been referred to the Attorney General for

legal action.


MINUTES

JUNE 9, 2016

5

RECESS

Dr. House declared the meeting in recess at 8:40 a.m. for the purpose of holding committee meetings.

Upon the conclusion of the committee meetings, Dr. House reconvened the meeting at 2:00 p.m.

LICENSURE COMMITTEE Dr. Gross presented the Licensure Committee report as a motion. The motion was seconded by Dr.

Powell. The Board accepted the report by unanimous vote.


Petitions for Variance / Waiver of Rules

Name Rule Decision

BANSAL, VIPIN KUMAR 360-.02 (5) Granted

CHAND, CHANTELLE 360-2-.09 (3) (b) Granted

HARRELL, SEAN 360-2-.09 (3) (b) Granted

LOPEZ, JOSE 360-2-.01 Granted

PUTHUVEL, SHAJI 360-2-.02 (5) Granted

TATUGADE, ANIKET 360-2-.02 Granted

Requests from Applicants / Licensees

Name Request Decision

D.M. Refund application fee. Granted

J.W. Refund application fee. Denied

N.V. Release certain application documents. Granted

R.V. Release certain application documents. Granted

Applications Not Approved

Name Decision

J.M. Allow to withdraw reinstatement application.

J.W. Allow to withdraw reinstatement application.

M.G. Deny initial licensure application.

D.M. Allow to withdraw initial licensure application.

T.A. Table. Invite for interview.

C.E. Table. Invite for interview.

R.N. Table. Require clinical skills assessment.

S.P. Table. Invite for interview.

J.W. Table. Invite for interview.

V.A. Table. Invite for interview.

P.A. Table. Require documentation of continuing medical education. Unless

Administrative License is requested, require clinical skills assessment. Allow

to withdraw application upon request.

C.W. Table. Unless Administrative License is requested, require clinical skills

assessment.


MINUTES

JUNE 9, 2016

6

Other Business

1. Adopted a policy to administratively approve applications for educational training certificates and

applications for administrative licenses, so long as the applicants have no malpractice or other

practice and/or license history issues.

2. Authorized the Licensure Unit Manager to approve applications for residency training permits

upon receipt of ECFMG test result notifications and all other required documentation, so long as

the applicants have no practice and/or educational history issues.

3. Authorized the Licensure Committee to review and approve applications for residency training

permits that are received and/or completed between June 9, 2016 and July 7, 2016.

4. Directed the staff to draft a letter to the Centers for Disease Control, as well as a newsletter

article, concerning Administrative Physician Licenses.

Approved Applications for Educational Training Certificate:

Name Certificate #

OSTERMAN, FLOYD A JR 1009

ROIZENTAL, MOISES 1008

Approved Applications for Reinstatement of Residency Training Permit:

Name Permit #

WILLIAMS, PELHAM LEONARD IV 7650

Approved Applications for Initial Residency Training Permit:

Name Permit #

AARON, HAYDEN KOEHLER 8400

ABDALLAH, AMJAD 8370

ADEDAPO-JIMOH, OLASUPO 8342

AHLSTROM, SHANE MICHAEL 8343

AHMAD, IMRAN 8367

AHN, JANICE SEULGY 8356

ALI, SHOHEB S 8389

AMIN, PARTH N 8401

AWAD, MOSAAB 8371

BARNES, MATTHEW ALAN 8431

BARRIENTOS, OSVALDO ANDRES 8398

BARRS, CHADWICK DALE 8344

BASILY, ARSANY IBRAHIM 8338

BATAL, HANNIE S 8394

BENSON, RACHEL HANNAH 8435

BERNADIN, TASHINEA MICHELLE 8406

BIEBIGHAUSER, KC 8372


MINUTES

JUNE 9, 2016

7

Name Permit #

BILLINGS, JUSTIN ALEXANDER 8442

BOOKOUT, GREGORY PAUL 8390

CARSTENS, DAVID MICHAEL 8412

CAWLEY, CLINTON MATTHEW 8403

CELANO, EMMA CHRISTINE 8373

CHAVARRIAGA, ALEJANDRO 8399

CHIRANJEEVI, SIVA 8443

CHOKSHI, YERA VIRAL 8330

COLE, BRITTANY RENEE 8339

CRISONA, FRANK JOSEPH III 8358

CUKO, EVIS 8345

DANIEL, STEPHEN PAUL 8354

DE CROOS, MARY CHIRANKA 8355

DE LA LUZ, TATIANA 8357

DE SIMONE, LAURA MARIE 8426

DESAI, KEVAN SUBHASH 8423

DEUTSCH, KALIE ANN 8374

DODD, ASHLEY NICOLE 8375

DOWNEY, GEORGE THOMAS 8441

DZIUBA, KAYLA KRISTINE 8361

EAMES, LACEY JUNE 8437

ELREDGE, KYLE STEVEN 8376

ESSALI, NORAH 8445

FERNANDEZ, JENELLE MARIE 8434

GAMBOA, ADRIANA CAROLINA 8377

GANCAR, JESSICA LAUREN 8413

GARCIA, MARIA VICTORIA 8378

GARLAND, WESLEY ALLEN 8438

GUNNETT, WILLIAM MARSHALL 8408

GUPTA, SHABNAM 8379

HANS, GURKAMAL 8366

HARRELL, SEAN ALEXANDER 8410

HATIC, HARIS 8396

HAYES, BENJAMIN MICHAEL 8391

HEATH, JODI-ANN 8405

HOLT, MAYYADA FAIZAH 8335

JEROME, MAIRIN ASHLING MURPHY 8380

JOHNSON, CARL ANTHONY JR 8432

JORDAN, DESHA MELISSA 8369

KALATHIL, ALKA ABRAHAM 8334

KHAN, SAAD ALI 8428


MINUTES

JUNE 9, 2016

8

Name Permit #

KING, LISA MARIAN 8436

KLENK, LYNNDSEY MICHELLE 8331

KOBLICK, SARAH BETH 8427

KOERNER, JOSHUA N 8407

LAKE, SAMANTHA ANN 8362

LARSEN, REBECCA LYNN 8420

LEE, JIN SUNG 8397

LEE, RACHEL MICHELLE 8381

LEVINA, YELENA 8402

LIU, YING XIN 8382

LOVASIK, BRENDAN PAIGE 8383

LUDI, ERICA KRISTEN 8384

MAALI, LAITH 8409

MARIANO, JOSEPH LAGUANA 8353

MATAR, ABRAHAM JAMIL 8385

MCCULLOUGH, IAN LAWRENCE 8392

MERRITT, MONIQUE L 8336

MILLER, ROYCE CLIFTON 8440

MILLER, SERENA NICOLE 8425

NIEHUUS, RACHEL MARIE 8386

NORMAN, ASHLEY DIANA 8414

NOWACK, TIMOTHY ELLIOT 8429

OLAGUNJU, TOLANI TEMITOPE 8444

PADMANABHA, DEEPAK 8416

PAISIBLE, JAMES DANIEL 8433

PARIKH, VRATI DIPAK 8337

PARKER, JAMES COLE 8430

PATEL, SMEET 8346

PERRY, RICHARD LANE 8347

POORAK, MITRA DEAN 8421

QURESHI, OWAIS A 8411

RAHMAN, HUMA 8333

REDDY, TANYA LUKE 8365

REDMOND, MICHAEL LEE 8393

RENKEN, BRYAN 8348

ROSS, YAEL SARAH 8422

RYAN, CHELSEA ROSE 8363

RYAN, NATHAN E 8349

SAIBU, ABIOLA OMOLABAKE 8360

SHAPIRO, SAMUEL ELLIOT 8395

SHEPARD, ALEJANDRO 8340


MINUTES

JUNE 9, 2016

9

Name Permit #

SHOLES, TIPTON DOVEY 8415

SINGHAL, RISHI 8446

SMITH, MARCHE TEON 8341

SPARKS, TYLER GREGGORY 8350

THOMPSON, ROBERT GILMORE 8404

UKWU, YVONNE NNENNIA 8419

UTHAMAN, MARVIN 8332

VU, QUANGHUY NHAT 8439

WEI, SHIPENG 8368

WHITE, JOSEPH KARL 8359

WOO, REBECCA JO 8352

WOODY, JOHN DENNIS 8424

WUILLEUMIER, JEAN-PAUL 8418

YEE, VICTORIA WEI-YA 8417

YOO, JAMES JAE-HYUNG 8351

YOUNGSTROM, MALLORY LYNN 8387

ZACHARY, GRANT EUGENE 8364

ZAPATA, DAVID SAMUEL 8388

Approved Applications for Reinstatement of Physician Licensure:

Name License #

ANDERSON, JOHN EDWARD 27484

BEALL, JAMES HARVEY III 27492

DESAI, BIREN B 51925

DINGLASAN, JOSEPH R 18799

FEOLE, JOHN BENEDICT 65656

HAIDAR, AQEEL 46767

MCCLUNG, JOHN ARTHUR 39864

MORSEK, JOHN ROBERT 61130

NANCE, DALE RUSSELL 48448

PROTIGAL, MELISSA GRACE 55365

SEKAR, SUNANDHA 39229

SMITH, VERNON C JR 15510

Approved Applications for Initial Physician Licensure:

Name License #

ABENOZA, PASCUAL 76250

ADRISH, MUHAMMAD 76254

AFEWORK, MESFIN 76230

AGOCHUKWU, UZONDU FRANCIS 76259

AJAYI, OLUMIDE ADENIYI 76284


MINUTES

JUNE 9, 2016

10

Name License #

ALBERTSON, CHRISTOPHER MICHAEL 76232

ALI, IRSHAD 76264

ALLEN, LAVEIL MASHUN 76266

ANDERSON, BROOKE 76268

ANDERSON, GRETCHEN NICOLE 76269

ANDERSON, SHAE STEPHEN 76270

ANYANWU, TRACEY 76373

APPAU, KWEKU 76272

ARNOVITZ, PEARL ANN 76274

ASHRAF, SAMIRAH MUNIR 76286

AUGUSTIN, BROOKE 76290

AVERY, RASHIDA ALLEN 76294

AWAAD, MOHAMMED 76236

BANSAL, VIPIN KUMAR 76242

BAUSER-HEATON, HOLLY 76296

BEHBAHANI, TURANG ED 76298

BENARROCH-GAMPEL, JAIME 76380

BISHNOI, RAM JEEVAN 76299

BISSLER, JOHN J 76301

BLAIZE, MARIE DR 76302

BOAKYE, KWABENA 76303

BOYD, JEREMY 76304

BOYER, FREDERICK AUSTIN 76306

BRENNAN, JOHN A 76308

BROCK, KATHARINE ELIZABETH 76309

BROOKS, THOMAS JEFFERSON IV 76311

BUENO, YOLIN AUGUSTO 76312

CARRION-JONES, MONICA JEANETT 76314

CHAMPAGNE, BRADLEY PAUL 76317

CHARRIER, REGINA CHARRIER 76381

CHO, SUNG ROCK 76319

CHOI, MARY JOUNG WON 76378 (Administrative License)

CHOKSI, KASHYAP B 76320

CHUANG, PHILIP YEN YEA 76322

CHUNG, EUNJIN 76323

COSTE, HILDA ELIZABETH 76243

DANIELS, AMARIS EVANS 76324

DAVENPORT, WILLIAM W 76325

DAVIDSON, KELSEY 76326

DAVIDSON, NICOLE ADRIANA 76327

DIPOCE, JASON MARC 76329


MINUTES

JUNE 9, 2016

11

Name License #

DRYZER, SCOTT RANDALL 76376

EFOBI, ANTHONY UDOKWU 76331

EHSANI, LALEH 76332

ENWEZOR, CHUKWUNYELU 76336

EZEWUIRO, OBIAGELI CHINAKA 76245

FAASSE, SARAH 76337

FABER, THEODORE TOM 76339

FERREIRA, YVONNE BARBARA 76247

FITHIAN, WILLIAM TAYLOR III 76340

FLASTER, RONALD D 76248

FLETCHER, DEREK 76371

FRANCIS, SERENE ANNIE 76341

GAFFNEY, VANDY THEODORE II 76342

GAINOR, DANIELLE 76343

GALAT, JOHN A 76345

GANDHI, JONATHAN 76346

GARCIA-HERNANDEZ, ALEJANDRO 76292

GARRICK, BENJAMIN 76348

GILBERTSON, LAURA 76361

GOYAL, DHARMENDRA KUMAR 76249

GUPTA, PALLAVI 76349

HAFER, AMANDA ELIZABETH 76211

HALFORD, BRITTNE A 76262

HALL, GRAVES SCOTT 76214

HALL, HAROLD ANDREW 76196

HAMEED, FARWA 76234

HAMMOND, MATTHEW WILLIAM 76119

HANDRATTA, VENKATESH DHANANJAY 76148

HAYLIE, SHIMELS 76334

HAYNES, RENEE MONIQUE 76287

HEBERT, LAUREN MARIE 76318

HEDLEY, JEFFREY STEPHEN 76276

HENDERSON, DEANNA 76223

HERBIG, PETER KARL 76355

HOCH, MICHAEL JOSEPH 76121

HOLLANDER, JUDD 76131

HUFFINGHAM, ASHLEY 76138

HYATT, DARREN JAMES 76133

IBELEMA, DANIELLE BOMA 76263

IBIE, NOWOGHOMWENMA CHARLES 76354

INGLESE, MARC 76297


MINUTES

JUNE 9, 2016

12

Name License #

IVANAUSKAS, SAULIUS 76221

JACKSON, JUSTIN MYRON 76288

JACOBS, JULIE 76275

JAIN, ANKIT 76244

JAVIDFAR, JEFFREY 76252

JIANG, JIMMY 76128

JO, JAMES KIM 76155

JUDGE, ERICA LATISHA 76347

JULIANO, BARBARA MARIE 76338

KARKI, YALIZA 76330

KASSAMALI, ALI 76333

KAVOLUS, JOSEPH JOHN 76217

KAVURI, RATIKA S 76321

KHAN, ASMA LATEEF 76237

KHAN, MONICA 76344

KHAN, ZARAQ 76226

KINER, JASON LAWRENCE 76124

KIRKLAND, BRANDON WINSLETT 76350

KISSIEDU, JULIANA 76265

KNIGHT-NELSON, LINDA JOY 76258

KOCH, CHRISTOPHER TROY 76362

KOEPPEL, WILLIAM 76204

KONERU, VEDA LAKSHMI 76253

KORNBLATT, BENJAMIN 76305

KOSIK, RUSSELL OLIVER 76246

KRASHIN, JAMIE 76251

KUMAR, NAVEEN 76260

KUNTZ, JOANNE GOULD 76316

KUNTZ, RICHARD 76168

LACCHEO, IKUKO 76375

LAKHANPAL, SANJIV MD 76357

LAMIKANRA, OPEYEMI ELAINE 76202

LAMOUREUX, CHRISTINE ANNE 76377

LAMPTEY, LESLIE 76352

LANHAM, JASON S 76328

LAOTHAVORN, JUNTIRA 76279

LEAVITT, MITCHEL ALTMAN 76160

LEE, LATOYA JEAN 76289

LEE, MONICA HYUN JOO 76307

LEFEVRE, ASHLEY SUZANNE 76353

LOGAN, MELISSA 76273


MINUTES

JUNE 9, 2016

13

Name License #

LOHMANN, KATHRYN MARGARET 76241

LOPEZ, CHRISSY 76313

LOPEZ, ENRIQUE PATRICK 76310

LOUGH, CHRISTOPHER MICHAEL 76199

LUTGRING, JOSEPH DANIEL 76360

LYNCH, MARSHA CAMILLA 76165

MACKEY, ROBERT ANDREW 76278

MALIREDDY, RAHUL REDDY 76174

MANOHAR, AKSHAY 76280

MANSOURI, AZAD 76153

MANU, YAA 76283

MARSHALL, KEIR DOUGLAS 76295

MARTIN, JONATHAN GILBERT 76229

MARTINO, JENNY LIVIA 76363

MASSOLL, NICOLE ANN 76374

MATHUR, JAY SIMLOTE 76257

MAULDIN, JILL G 76366

MAURICE, NICHOLAS MICHAEL 76171

MAYHALL, GEORGE ALLEN 76282

MCCANN, ASHLEY LAUREN 76369

MEDINA, PAMELA 76359

MEHTA, AMISHA S 76261

MERSHA, KAREZHE TIGINEH 76151

MESSERSCHMIDT, CORY ARTHUR 76255

MIER, MARY LEE 76143

MILLER, DEON 76271

MITRA, SUBHASH CHANDRA 76135

MONAHAN, MICHAEL BLAIR 76351

MONDERSON, THESSELON 76367

MOUSAVI, FATEMEH 76267

MUESSE, JASON LEONARD 76178

MUFTAH, LOAY AHMED 76281

MURPHY, JAMES ANTHONY 76126

MUSYIMI, SUSAN NDUKU 76132

MUZAHIR, SAIMA 76335

MWANGI, WANJA E 76118

NAGAR, ANUSUIYA 76136

NANOS, KATHERINE 76372

NEIMKIN, MICHAEL GEORGE 76141

NELSON, KATHRYN JOY 76207

NEWTON, DAVID 76163


MINUTES

JUNE 9, 2016

14

Name License #

NGUYEN, BINH VINH LE 76285

NGUYEN, JONATHAN 76300

NGUYEN, KHANH QUOC DO 76293

NJOKU, VICTOR C 76291

NNODIM, AHAMEFULA 76122

NORELIUS, RONA 76358

NUTANKALVA, LAVANYA 76150

OBIAKA, CHIGOZIE UZOCHUKWU DR 76356

ONUIGBO, MACAULAY 76209

ORLOSKY, MICHAEL JOE 76256 (Administrative License)

OVERMAN, KELLY 76315

OYEKOYA, ADEBOLA IRETIOLA 76277

PATEL, BHAVIKA RAJANIKANT DR 76120

PATEL, GAURANG PUNAMCHAND 76123

PATEL, JAY GIRISH 76125

PATEL, JOY 76127

PATEL, RUCHI 76146

PATEL, VAISHALI 76129

PATIDAR, VINIYA 76130

PENMETSA, RAM GOPAL 76134

PHILIPSBORN, REBECCA 76137

PIRKLE, CHRISTEN SUZANNE 76139

POLING, JUSTIN SCOTT 76140

PORUBSKY, CAITLIN 76142

PRABHU, SANJIV DR 76144

QUINLIVAN, EVELYN BYRD 76145

QUINONES, LUIS ANTONIO 76117

RADOSEVICH, MISTY ASET 76365

RAMAN, BHARGAV 76147

REYES, LORETTA 76149

RICHARDSON, ZACHARY 76157

RICKS, NITASHA MENON 76364

ROCHE, WILLIAM PATRICK IV 76152

ROCUTS MARTINEZ, KLIFFORD ALEXANDER 76154

ROWE, KRYSTINA ASHLEY 76156

RUSSO, CHLOE LAN 76158

SANDERS, LINDA 76159

SARDI, ALEJANDRO HUMBERTO 76161

SCALCIONE, LUKE 76162

SCHIAVO, DANTE NICHOLAS 76164

SCHNEIDER, THOMAS MICHAEL 76166


MINUTES

JUNE 9, 2016

15

Name License #

SCHULLER, KYLE WILLIAM 76167

SCHURDELL, MICHAEL SCOTT 76169

SCHWARTZ, AARON REUBEN 76370

SENGUPTA, SOMA 76170

SEVDY, TRISTAN 76172

SEWELL, ELIZABETH KAREN 76173

SHAFEY, AMIRA 76175

SHAH, MICHAEL 76176

SHAKER, SHAUN SANTHOSH 76177

SHAPOVAL, ANTON 76179

SHIH, EDMOND 76180

SHILDT, NATALY DE LOS ANGELES 76181

SHIN, AH RIM 76182

SHYELLE, MAURIEKE DEER 76200

SIBLEY, CHARLES ALLAN 76183

SIDHPURA, VINIL 76184

SIMELTON, BERNARD HUGH JR 76201

SIMMS, K'JOY JASMINE ANTHEA 76203

SINGH, BHAVANA PENDURTHI 76185

SINGH, SATYA 76187

SINHA, RAINA 76186

SMALLS, NORMA MICHELLE 76205

SMITH-WINFIELD, CHRISTINA MARIE 76206

SOKKARY, NANCY 76208

SOLIMAN, JOHN SELIM 76368

SONG, CLIFFORD 76210

TAGHIZADEH, PANTHEA 76188

TAJ, JABEEN 76189

TATUGADE, ANIKET ASHOK 76212

TAYLOR, ANGELETA 76190

TAYLOR, MICHAEL ASHLEY 76191

TAYLOR, SARAH KRISTEN 76213

THIEL, JAMES MICHAEL 76379

THOMAS, TIMOTHY NATHAN 76192

THOMPSON, ALLISON HARRIS 76193

TIFFEE, AARON SCOTT 76215

TODD, SHEEL 76194

TROTTA, BRIAN 76195

TRUSSELL, JOHN KERWIN 76197

TSAI, YI JOU 76198

VIERA-NEGRON, KARLA AITME 76216


MINUTES

JUNE 9, 2016

16

Name License #

VU, ANH-THU NGO 76218

VULAVA, SRIKRISHNA 76219

WANG, LIHUAN 76220

WANTA, BRENDAN THOMAS 76222

WATSON, JONATHAN RICHARD 76224

WATSON, MELISSA J 76225

WHITE, FRANKIE HUGH JR 76227

WHITE, SHENITA 76228

WHITFIELD, JOHN DAVID 76231

WU, ZHEN 76233

YIRENKYI, HENAKU KWADWO 76235

ZAIDI, TAKI A 76239

ZHANG, SHUANG QIN 76240

ZHANG, YUANHUI 76238

Applications to be Approved upon Receipt of Additional Information:

Name File #

C.C. 75485

D.A. 74673

J.M. 75119

K.H. 74977

K.S. 74736

M.R. 75653

P.P. 75307

S.E. 74545

S.P. 75546

S.S. 75297

D.M. 75501

PHYSICIAN ASSISTANT COMMITTEE Dr. Antalis presented the Physician Assistant Committee report as a motion. The motion was seconded by

Dr. Mohan. The Board accepted the report by unanimous vote.


Approved Requests for Additional Duties:

Physician Assistant (License #) Supervising Physician (License #)

BOLTON, CASEY (7500)

1. Cosmetic filler injections

2. Neurotoxins

MULBERRY, MICHAEL JACOB (50725)

CURTIS, BERKLEY CALVIN (5534) HEAD, LYNDSAY WALTERS (69864)


MINUTES

JUNE 9, 2016

17

1. Central lines

2. Chest tubes

3. Intubation

4. Thoracentesis

DANIELS, CARA (7031)

1. Arterial lines

2. Intubation

3. Pulmonary artery catheters

BENDER, WILLIAM SCOTT (73903)

EASTERLING, SIDNEY ADAIR (6138)

1. Image-guided abdominal abscess drainage

2. Image-guided liver biopsy

3. Image-guided lung drainage

4. Image-guided thyroid biopsy

SMALL, WILLIAM CLARK (31836)

FRIEDMAN, MATTHEW (7111)

1. Central lines

2. Chest tubes

3. Intubation

4. Thoracentesis

SWENSON, COLIN (74378)

REGER, HEATHER DANIELLE (5509)

1. Central lines

2. Chest tubes

3. Intubation

4. Thoracentesis

BROWN, ANGEL (74482)

SIEDOR, KATHERINE MARY (7654)

1. Botox and Dysport injections

BABCOCK, MELISSA DAWN (59368)

TIAN, LARISSA (5526)

1. Central lines

2. Chest tubes

3. Intubation

4. Thoracentesis

BROWN, ANGEL (74482)

Tabled Requests for Additional Duties:

Physician Assistant Supervising Physician

H.P.

1. Diagnostic and therapeutic paracentesis

A.Q.

Approved Applications for Reinstatement of Physician Assistant Licensure:

Physician Assistant License # Supervising Physician (License #)

JONES, GARY PAUL 3366 (No supervising physician approved)

ROBB, DANIELLE LINDSEY 5722 CRANFORD, MATTHEW S (34801)


MINUTES

JUNE 9, 2016

18

Approved Applications for Initial Physician Assistant Licensure:


ALBRITTON, JULIAN 7996 FRAY, ALICE M (66598)

AMAN, JESSICA LYNN 7999 (No supervising physician approved)

BECK, JESSICA ELIZABETH 8009 FABREGAS, JORGE A (56556)

BERMAN, ASHLEY ELISABETH 7995 DUKES, RICHARD GERALD (51875)

BOOS, EDWARD PHILIPP 7994 PENDLETON, ALBERT MARTIN (68965)

BRANNEN, JODI 7975 WILLIAMS, SHAWN RAY (66841)

CUMBIE, ERICA 7974 DUKES, RICHARD GERALD (51875)

ECKERT, JACQUELINE 8003 BARBER, WILLIAM ALAN (25525)

ELLIOTT, ASHLEY ELAINE 8000 HUM, MONICA ANN (53247)

FLANAGAN, ERIN 7972 (No supervising physician approved)

FREEMAN, CAROLINE CLARK 7993 REDDY, ASHOK SATTY (39449)

FRUTCHEY, AMIEE MORGAN 7978 COOPER, WILLIAM ARTHUR (37977)

GIERKE, KRISTY JOANNE 7973 BROCK, CHAD JASON (54795)

GIGLIO, MICHELLE 8002 ROBINSON, BURKE PAUL (39921)

HALES, DELANEY STOVALL 7977 SPIEGL, PAUL VICTOR (25045)

HASS, CHRISTOPHER BRIAN 7992 JENSEN, ERIC EUGENE (50304)

JAGOR, HAYDEN SUTHERLAND 7991 PATEL, JITESH VINOD (65869)

JENKINS, JESSICA LAUREN 8007 BLANKS, KEITH ANTHONY (52042)

KIMBLE, ERIN GROH 7970 (No supervising physician approved)

LONG, DARCY MCDONALD 7990 ROMAN, CHARLES PAUL (43757)

MALONZO, BENJAMIN LAGUITAR 7976 DUGGAN, MICHAEL (69400)

MASSAD, GEORGIANA MOODY 7989 JONES, JOHN ELDRED (58886)

MATHENY, ELIZABETH MARIE 8001 PARAMESH, SRIRAM IYER (47129)

MATHEW, MARINA 8008 ANTIN, TODD MITCHELL (36495)

MCDONALD, JESSICA ELIZABETH 7988 PRINGLE, KIMBERLY DIANA (69425)

MCPHAIL, REBECCA CLANTON 7979 (No supervising physician approved)

MENTON, KEITH 8005 ROGERS, STEPHEN ERNEST (26180)

MUSCIANO-HOWARD, ALLYSON 7987 GUY-CRAFT, WANDA (64224)

POWELL, SHEENA 7986 WHITLEY, MATTHEW KYLE (66673)

RALSTON, JORDAN NIX 7981 (No supervising physician approved)

RAY, CRISTEN LEA 7971 PATEL, CHIRAG HASMUKH (58715)

ROSENBERG, MAX RYAN 7985 PATEL, HIREN (70619)

RUTLAND, WILLIAM CARY 7984 SANDIFER, BRETT LEE (51381)

SANCHEZ, MONICA SULEMA 7997 SATUR, NANCY MARLENE (70772)

SMITH, ANN KATHRYN 7980 (No supervising physician approved)

STEFFEN, KATHLEEN ELIZABETH 7983 BACKER, THOMAS SCHEELE (30711)

STONE, CAROLINE CARVER 7998 (No supervising physician approved)

WARD, JOANNA MARIE 8004 JACKSON, ALVIN (66163)

WEDDINGTON, JASON TYLER 7982 JAMES, PLAS TERRENCE (32756)

WILLIAMS, MALLORY STEWART 8006 RENDON-GARCIA, JOSE MIGUEL (37655)


MINUTES

JUNE 9, 2016

19

Approved Applications to Add/Change Supervising Physician:


ANDERSON, CHRISTINE ANN 4789 CARNEY, KENNETH JEFF (50349)

ANDERSON, CHRISTINE ANN 4789 KROWICKI, JOHN ANTHONY (25880)

ANDERSON, CHRISTINE ANN 4789 DAVOODI, PUYA (62833

ANDERSON, CHRISTINE ANN 4789 GAY, SOPHENIA REBECCA (67868)

BABABEKOVA, YANA 6758 PATEL, DHARMESHKUMAR (55264)

BALDWIN, SAMANTHA DECAMP 6199 LU, JOHN TUAN (40727)

BASSEY, SHIRLEY EPHRAIM 6593 CARTHON, BRADLEY CURTIS (66462)

BAYES, EMILY KAY 7461 BUSBEE, JONATHAN FRANK (40336)

BENCE, SARAH 6477 MORGAN, CHRISTOPHER (66151)

BENDER, MEAGAN ANNE 7178 AUGUSTIN, GUY YVES (70852)

BLAIR, EMORY SCOTT 7540 GARRETT, JOSHUA LEON (58866)

BOETTCHER, KATHLEEN 6568 KAKKAR, AMAN KUMAR (56303)

BOLTON, CASEY 7500 MULBERRY, MICHAEL JACOB (50725)

BOZEK, BROOKE DOUGLAS 7562 ROARTY, JOSEPH (61648)

CAMP, ALEXANDRA V. 7181 GOSS, JENNIFER G. (57367)

CASANOVA, PEDRO JUAN 2333 OJIAKU, ALAMEZIE (69819)

CASANOVA, PEDRO JUAN 2333 QUINLAN, JESSICA ANNE (73135)

CASANOVA, ROSEMARIE 5231 GAY, SOPHENIA REBECCA (67868)

CASTILLO, LORENA ADRIANA 7131 KALAITZIDIS, GEORGINA (56186)

COLEMAN, ELIZABETH BLAIR 3744 SASSER, THOMAS MICHAEL (53152)

COLLINS, JESSICA ELLA 4460 PATEL, NEAL CHHITU (71755)

CONNER, AMANDA MICHELLE 5057 GILBERT-GREEN, JACALYN (74801)

CURTIS, BERKLEY CALVIN 5534 HEAD, LYNDSAY WALTERS (69864)

DAPAAH, RALPH 6248 HANDA, AJAY (46599)

DARBY, JOLINA M 7339 WETSTONE, JORDAN MATTHEW (30239)

DARE, TIMOTHY JAY 3559 FREDERICK, DAVID MICHAEL (74006)

DAVDA, NARESH MANEKLAL 7937 FLEMISTER, AKEEM (74137)

DAVIS, FRANKIE ELIZABETH 4429 KELLY, ROBERT A (34872)

DAYA, UMA TRIVEDI 5779 LEE, JAMES YONG (56583)

DEGRAW, KATY 7722 VICCHRILLI, MOLLY REES (58364)

DESAI, BIJAL JYOTINDRA 6335 ASTIL, BEFIKIR (73741)

DESRUISSEAUX, NICOLE 7738 FLEXON, PHILLIP BILLINGS (31737)

DEV, JASMINDER SINGH 5853 GANDHI, KAMLESH SHANTILAL (27190)

EID, CHRISTINA KHALIL 5855 DESAI, HARSHEEL H (70874)

EVBUOMWAN, ENOMA 7457 FLEMISTER, AKEEM (74137)

FAZEKAS, ALICE FISHER 4858 GALE, DAVID WILLSON (43618)

FISHER, GREGORY LEE 2916 ALLEYNE, RON (70518)

FORRISTER, LORI BRUMIT 1543 PRYOR, HEATHER ANNALEE (44310)


MINUTES

JUNE 9, 2016

20


FRIEDMAN, MATTHEW 7111 SWENSON, COLIN (74378)

GARCIA, SHAWN DWAYNE 7229 RAFEEDIE, GEORGE KALEEL (67591)

GIECK, RICHARD E 7451 FILMORE, GERALD L (50288)

GIST, JULIAN CHRISTOPHER 4861 OJIAKU, ALAMEZIE (69819)

GLOBERMAN, MARK A 3396 SWARTZENTRUBER, GARY (63965)

GROMADZKI, MARY 3057 SMITH, BENJAMIN ROY (44338)

HANLON, JENNIFER 7589 SYROP, TAMA LYNN (43135)

HANSANA, BINA PATEL 5259 FRIEDLAND, LANCE BRIAN (28268)

HARDIN, TRAVIS KEITH 7192 GONZALEZ, RAUL ALBERTO (24942)

HARRIS, MARGARET F. 4041 GBADEBO, OLUFOWOBI SUNDAY (54096)

HARRIS, MARGARET F. 4041 LICHTMAN, MICHAEL STEPHEN (44003)

HERMECZ, HILARY LEIGH 7806 PATEL, HIREN (70619)

HERSCH, THOMAS ELLIOT 5859 DI BLASI, JOHN JAMES (75206)

JOHNSON, FRANCIS NICOLE 6284 MCLEOD, DONALD SCOTT (22591)

JOHNSON, LAURA NICOLE 4660 MCMAHON, MICHELE MARIE (64679)

JONES, TRACI TAYLOR 7877 BOOKOUT, ANGELA LOVE (68485)

KERR-GRIFFIN, KIMBERLY 2396 ROBINSON, RANDY GERALD (35987)

KESHWANI, YASMEEN 5986 KENNEDY, SHEILA (68227)

KRUENEGEL, KEVIN LOUIS 5820 TAYLOR, COLLEEN ANN (63967)

LAMB, JOSEPH 5768 JOHNSON, MICHELE MARIE (53763)

LEAVITT, BLAIR ALAN 6927 BUSHNELL, BRANDON DUBOSE (61216)

LEE, CHANTEL MARIA 5514 ACQUAH, FRANCIS KWAME (38160)

LIDELL, JOHN MARK 2952 GILBERT-GREEN, JACALYN (74801)

LYTLE, NICOLE ALICIA 3771 MCLAREN, JOHN RANDON (21749)

MALCOLM, RONALD MAURICE 2081 DUCHYNSKI, MICHAEL PATRICK (71336)

MARTINELLI, MICHAEL PAUL 4436 LEFKOVE, BENJAMIN (72629)

MATTINGLY, JILL RAE 3283 KELLER, SCOTT TERRY (24445)

MCELMURRY, ELIZABETH 7485 MOON, KYONG ROK (63374)

MEHTA, KARMA D 6676 SELSER, HELEN GORDON (29529)

MELKUS, CAROLYN M 7894 MECCA, ANDREW THOMAS (36574)

MORROW, BRANDON LEE 7888 HAZZARD, MATTHEW AARON (74233)

MURRELL, BRIAN PATRICK 5100 ARKIN, DAVID BARRY (28136)

NAJARRO, GABRIEL R 6368 PATEL, DHAVAL D (72394)

NCHO, CLEMENT A 6000 RAMSUE, CLAYTON MARCELLUS (49938)

OPOKU-AMANKWAH, PATRICK 5919 NOYES, CHRISTINA DITHMER (58542)

PAGADALA, REKHA 5410 KOKENES, CONSTANTINE (30334)

PALMER, ANTRON JAMAL 6942 LU, JOHN TUAN (40727)

PANDYA, KALYANI ARUN 7671 BURSTEIN, FERNANDO DAVID (32141)

PATEL, AAKASHI 6792 KAMAT, PARESH (70212)

PEARCE, SHANNON LYNN 4196 ESTES, JAMESON ANDREW (48852)

RANDALL, EMILY KIRSTEN 7635 MILLER, JACK LEON (24987)


MINUTES

JUNE 9, 2016

21


REGER, HEATHER DANIELLE 5509 BROWN, ANGEL (74482)

ROBINSON, GILLIAN ANDREA 5970 PODDAR, SATISH BABULAL (43264)

ROBINSON, SUSAN PAULETTE 2513 OKWUMABUA, ISIOMA (70256)

ROSE, JAMES ERIC 3570 GILBERT-GREEN, JACALYN (74801)

RUBIO, SUSAN J 6752 HUONG, JOE TZONG-JYH (65568)

RUSS, EMILY LYNN 6411 LAIPPLE, DOUGLAS KAY (21410)

SADOWSKI, CATHERINE KELSO 7818 DICKERSON, ELIZABETH ANNE (36136)

SALLY, DONALD E 2071 PARIKH, NARESH KUMAR (28851)

SAWYER, MARY RACHEL 7887 WOLFSON, ILYA (51860)

SAWYER, SOONJA LOUNAZA 6829 RANDOLPH, BRION VINCENT (68281)

SHELLITO, KAREN QUINN 2842 SHAY, ROBERT JOSEPH (40546)

SMITH, GABRIEL GORDON 5325 GILLIARD, FRED E (12468)

SPENCER, JASON C 3768 MUNRO, IAN (66226)

STANSELL, CHRISTOPHER ALLEN 5105 HARRIS, EUGENE HERBERT (59658)

STONE, DAWN 5977 GAY, SOPHENIA REBECCA (67868)

TAYLOR, COURTNEY NICOLE 4237 BURKMAR, JENNIFER ANNE (72437)

TAYLOR, TIFFANY ANN 5828 WOLFF, CRAIG EDWIN (34272)

THOMAS, REBEKAH EVELYN 6585 TATA, UDAY KUMAR (53413)

THORPE, BRIAN JOHN 5327 SUTHERLAND, GEORGE BEATTIE (62612)

TIAN, LARISSA 5526 BROWN, ANGEL (74482)

TRAN, NGOC BUU 6553 PENDLETON, ALBERT MARTIN (68965)

TRAN, NGOC BUU 6553 WILSON, DAWN R (47279)

TRAN, TAM HOANG 6554 PERDOMO, ONELIO EMILIO (22351)

TYWON, SHAWN EDWARD 2613 GUTIERREZ, RAYMOND ELIAS (57983)

VIGIL, HILDA 7526 MILLER, JACK LEON (24987)

WALDMAN, ASHLEY L. 5718 BAILEY, KATIE (73733)

WHITIS, NICOLE ANN 6503 CLURE, CHRISSIE GAYE (49281)

WILLIS, KANDI LAUREN 7204 MCCORMACK, THOMAS WAYNE (51255)

WOODS, CHRISTOPHER ALLEN 7755 GILLIARD, FRED E (12468)

CLINICAL PERFUSIONISTS COMMITTEE Dr. House presented the Clinical Perfusionists Committee report as a motion. The motion was seconded

by Dr. DeLoach. The Board accepted the report by unanimous vote.


Approved Applications for Initial Clinical Perfusionist Licensure:

Name License #

MILLER, HAYDEN DUANE 271

PRESTON, THOMAS JOHN 274


MINUTES

JUNE 9, 2016

22

Approved Applications for Provisional Clinical Perfusionist Licensure:

Name License #

GILMORE, SEBASTIAN G 268

HINTON, JACKLYN 272

LAMONTAGNE, ALAIN NICHOLAS JR 273

TREADWAY, ANNA 269

WALLER, CHELSEY ELIZABETH 270

Other Business

1. Directed the staff to follow up on an inquiry concerning the use of the letters “C.C.P.” in clinical

settings.

RESPIRATORY CARE PROFESSIONAL COMMITTEE

Cami McGarity presented the Respiratory Care Committee report as a motion. The motion was seconded

by Dr. Downey. The Board accepted the report by unanimous vote.


1. Approve of the following applicant requesting a twelve (12)-month Permit:

Armstrong State University

1. Harris, Allendra

2. Menard, Frederick – Table pending more information

Central Virginia Community College

1. White, Shaneka

Columbus Tech College

1. Caradine, Doron

Concorde Career College

1. White, Jennifer

Georgia Regents University

1. Ivey, Naeconda – Pending more information

Georgia State University

1. Aguilar, Iorena

2. Henderson, Jasmine

3. Lim, Elizabeth

4. Rogers, Kizzel

George C. Wallace Community College

1. Tindell, Anna


MINUTES

JUNE 9, 2016

23

Middle Georgia State University

1. Benford, Cassidy

2. Clance, Caleb

3. Fields, Jonathan

4. Huynh, Thao

5. Joyner, Brittany

6. Riley, Cierra

7. Stewart, Rebecca

8. Vaughn, Amber

9. Warren, Janna

South Western Community College

1. Marsocci, Nicole

2. Review of the following applicants requesting licensure by Reciprocity:

1. Abraham, Tiam

2. Brooking, Meredith – Pending more information

3. Campbell, Shirley

4. Clark, Sonya – Pending more information

5. Cochrane, Shenitra

6. Cooper, Marianne

7. Fobare, Hermina

8. Filimon, Vasile

9. Guyse, Nancy

10. Heath, Stephanie

11. Morrison, Christine

12. Paige, Erin Pending more information

13. Seigel, Shanna

14. Scott, Ramone – Pending more information

15. Smith, Randall

16. Taylor, Gregory Pending more information

17. Thomas, Archaiela

18. Walker, Chnette Pending more information

19. Webber, LaTony

20. White, Ashley – Pending more information

21. Williams, Carol

3. Review of the following applicants requesting licensure by Reinstatement:

1. Abdulahi, Burlie

2. Dorley, kou

4. The following given full licensure by Administrative Action:

1. Davis, Sherri

2. Griffin, Anthony


MINUTES

JUNE 9, 2016

24

3. Jackson, Toni

4. Jones, Sherelle

5. Massey, Peyton

6. Mathis, Chelsey

7. Mena, Gabriela

8. Osman, Ikraam

9. Roeder, Fharyn

10. Jones, Tanesha

11. Walton, Jacob

12. Williams, Jeremy

13. Akuffo, Joseph

Other Business:

Review Prior minutes regrading having license requirement change for TRCP upgrade to full licensure

RRT from NBRC. Staff research Laws/Rules on this matter.

ACUPUNCTURE COMMITTEE

Dr.Mohan presented the Acupuncture Committee report as a motion. The motion was seconded by Dr.

DeLoach. The Board accepted the report by unanimous vote.


Accepted the following Quarterly Report:

John Albright

Hannah Tran

Other Business:

Invited Li Jiang to join the advisory committee.

Accepted the list of limited licensees and supervisors.

COSMETIC LASER PRACTITIONER COMMITTEE REPORT

Dr. Gross presented the Cosmetic Laser Practitioner Committee report as a motion. The motion was seconded by Dr. Downey. The Board accepted the report by unanimous vote.

Approve of the following applicants for an Assistant Laser License:

Bridges, Logan

Bogle, Alexandra

Giddens, Talarie

Graves, November – Table for further information

NURSE PROTOCOL COMMITTEE Dr. House presented the Nurse Protocol Committee report as a motion. The motion was seconded by Dr.

Antalis. The Board accepted the report by unanimous vote.



MINUTES

JUNE 9, 2016

25

The Board determined that the following protocol agreements meet the provisions of

OCGA 43-34-25:

APRN DELEGATING PHYSICIAN

Bastia, Jean Gill, Ravinderpal MD

Bell, Lindsey Harper, Lina MD

Belouche, Renato Huong, Joe DO

Bowden, Allison Patel, Dipesh MD

Bowden, Allison Caldwell, Craig MD

Bowden, Allison Goodwin, Jeremy MD

Bowden, Allison Livingston, James MD

Bowden, Allison Manley, Haley MD

Bowden, Allison Baraltei, Florence MD

Bowden, Allison Woodall, Lee MD

Bowden, Allison Wilson Terri MD

Boyd, Pamela Poynter, David MD

Brinkley, Josephine Ludwig-Arona, Audrey MD

Brooks Sr., Damion Scott, William MD

Cameron, April Kelly, Patricia MD

Carpenter, Francine Jackson, Thomas MD

Cavazos, Sara Cloutier, Megan MD

Cheeseman, Karen Dutta, Eamon MD

Crawford, Randall Higgins, John MD

Davenport, Lottie Polow, Sarah MD

Day, Elizabeth Harbin, Anthony MD

Diskin, Lindsey Kalynych, Anna MD

Favis, Tara Sow, Charles MD

Felser, Carole Winokur, Mark MD

Fleming, Carrie Rogers, Benjamin MD

Folkert, Michelle Effinger, Karen MD

Ford Jr., William Brown Jr, James MD

Ford, Nicole Brown Jr, James MD

Hicks, Robert Ramsdell, Bruce MD

Holts, Kalato Amoa-Bonsu, Felix MD

Jackson, AnJanean Primrose, Melissa MD

Jani, Drashti Opanuga, Ademola MD

King-Byrne, Ava Caldwell, Craig MD

King-Byrne, Ava Frinks, Terrance MD

King-Byrne, Ava Goodwin, Jeremy MD

King-Byrne, Ava Hendrick Jr, Edwin MD

King-Byrne, Ava Joseph, Kirpich MD

King-Byrne, Ava Klassen, Robert MD

King-Byrne, Ava Baralatei, Florence MD

King-Byrne, Ava Bullecer, May MD

King-Byrne, Ava Livingston, James MD

King-Byrne, Ava Manley, Haley MD

King-Byrne, Ava Morris, Wayne MD


MINUTES

JUNE 9, 2016

26

King-Byrne, Ava Patel, Dipesh MD

King-Byrne, Ava Watson, Nancy MD

King-Byrne, Ava Westmoreland, Anon MD

King-Byrne, Ava Wilson, Terri MD

King-Byrne, Ava Woodall, Lee MD

Lipscomb, Cheri Sow, Charles MD

Marshall, Damali Onofre, Gabriel MD

Marshall, Tiffany Howard, Kenneth MD

Moore, Verreta MgBodile, Francisca MD

Moreland, Rayona Amoa-Bonsu, Felix MD

Muranja, Mary Vakharia, Mahaveer MD

Nicholson, Teresa Mixson, Robert MD

Nofziger, Angel Burkich, Robert MD

Oliver, Kristin Chin, Victor MD

Pingeton, Robin Figiel, Gary MD

Pulliam, Kira Beckford, Tanya MD

Raimondo, Kristine Darlington, Andrew DO

Rollins, Kalita Singhal, Sunit MD

Sauers, Caroline Hemphill, John MD

Siddle, Jennifer Montero, Aldemar MD

Spearman, Pamela Onofre, Gabriel MD

Stephens, Tammy Primrose, Melissa MD

Swift, Lisa Bullecer, May MD

Swift, Lisa Frinks, Terrence MD

Swift, Lisa Hendricks Jr, Edwin DO

Swift, Lisa Joseph, Kirpich MD

Swift, Lisa Morris, Wayne MD

Swift, Lisa Westmoreland, Anon MD

Tanner, Virginia Smith, Tania MD

Taylor, Dwayne Usoh, Fred MD

Thompson, Tessa Woodall, Lee MD

Thompson, Tessa Baralatei, Florence MD

Thompson, Tessa Caldwell, Craig MD

Thompson, Tessa Goodwin, Jeremy MD

Thompson, Tessa Livingston, James MD

Thompson, Tessa Manley, Haley MD

Thompson, Tessa Patel, Dipesh MD

Thompson, Tessa Wilson, Terri MD

Tripp, Dawn Spafford, Patrick MD

Unongo, Cindy Afridi, Zahid MD

Van Dorn, Terri Kelly, Patricia MD

Wacasey, Daphne Hindash, Osama MD

Webster, Robert White, Kelvin MD

Weigmann-Ross, Michele Danits, Harvey MD

Whatley, susan Virmani, Sharad MD

Yufenyuy, Mamboh Wright, Richard MD

Administrative Approvals

Almburg, Lauren Lee, James DO


MINUTES

JUNE 9, 2016

27

Alston, Marion Shiver, Marlene MD

Anderson, Christa Warner, Melissa MD

Bailey, Rhonda Jones, Ernest DO

Bain, Judy Genova, Kenneth MD

Barham, Jason Pirzada, Jehanger DO

Bhimani, Samreen Pirani, Safia MD

Bongiovanni, Delana Daniel, Gary MD

Borders, Virginia Wilkins, Jeff MD

Boyd, Jason Bass, Edward MD

Boyd, Jason Livingston IV, Joe MD

Bridges, Kathleen Acosta, Maria MD

Caballer, Lorene Hafeez, Nabeel MD

Cambell, Jimmy Woodard, Alfred MD

Choate, Elizabeth Ogunniyi, Modele MD

Choe, Julia Galan, Vincent MD

Clay-Keith, Sharon Risby, Emile MD

Cooksey, Karen Riser, Kenneth DO

Copeland, Christina Martin, Paul MD

Copeland, Miriam Waguespack, Scott MD

Couse, Tracey Walkup, Raymond MD

Crawford, Randall Giles, Paul MD

Davison, Wendy Moore, Karen MD

Decker, Laura Ofohoa, Kenneth MD

Duncan, Laura Dutta, Eamon MD

Esozobor, Cherri Moore, Karen MD

Falkner, Myron Rohit, Khanna MD

Faudree, Cyndi Hand, Joseph MD

Freeman, Charisma Desai, Saurabh DO

French-Mirtschink, Teri McKee, Scott MD

Friedl, Martha London, Dayna MD

Gainey, Tyrongala Khanna, Rohit MD

Garmon, Lindsey Pandya, Darshak DO

Garner, Jennifer Kirsch, Andrew MD

Gay, Rachel Allen, Justin MD

Graham, Latisha Lee, Peter MD

Harrelson, Lauren Ramesh, Kandallu MD

Harrelson, Lauren Lynch, Donald MD

Hart, Rebecca Reddy, Rani MD

Hawkland, Robin Winter, Jeffrey MD

Hayman-Jones, Shandora Vaughn, Mary Bell MD

Haynes, Twilla Shongo, Patrice MD

Hernandez, Odessa Stirne, Howard MD

Hornsby, Lauren Patel, Darshan MD

Hudson, Lori Lloyd, John MD

Jean-Philippe, Marjani Dyson, Kritstie MD

Jividen, Elaine Mathews, Ressy MD

Kang, Mindy Syed, Aazrum MD

Kennett, Marsha Ellis, Michael DO


MINUTES

JUNE 9, 2016

28

Knee, Laura Easley, Raymond DO

Knight, Tristia McCraken, Mark MD

Lattimore, Willie Galliano, Enrique MD

Law, Latonya Ajayi, Ganiat MD

Lee, Sook Hyun Kim, Chang Soo MD

Legg, Fred Thompson, Kenneth MD

Lemene, Kristina Costley, Chad MD

Lukano, Caroline Khan, Zia MD

Mascarin, Jennifer Fisher, Lyle MD

McCord, Frances Lemley, James MD

McDaniel, Jasmine Baruti, Dingave MD

Melvin, Heather Clay, Dwayne MD

Minkoff, Alice Gandhi, Kamlesh MD

Mori, Kathryn Bosch, Ortelio MD

Moxon, Jeannie Hall, Robert MD

O’Brien, Mallory Harper, Dennis MD

Odom, Jhaelyn Braswell, Precious MD

Olson, Sheryl Stirne, Howard MD

Opara, Mary Mihalovits, Karl MD

Parks, Diane Ross, Mary MD

Parrish, Jessica Waguespack, Scott MD

Patrono, Jane Collier, Millard MD

Patrono, Jane Andrist, Eric MD

Patton, Deanna Gerhardt, Charles MD

Paulk, Jane Hunter, Clarence MD

Peden, Alison Bledsoe, John MD

Pelican, Megan Gage, Alexis MD

Pence, Wendy Robinson, Randy MD

Peterson, Alison Wingate, Harry MD

Prestidge, Taryn Swayne, Angela MD

Price, Sarah Garrett, Joshua MD

Purdell, Kimberly Tift, William MD

Rakhmanova, Rano Moussa, Mohamad MD

Randels, Camden Fordham, Donald MD

Ridgeway, Sarah Thompson, Albert MD

Roseberry, Lisa Harris, Brent MD

Ross, Kimmarie Qayed, Emad MD

Schilinger, Rhonda Sanders, Alan MD

Schornack, Theresa Pullium, Patrick MD

Seagraves, Joseph Waguespack, Scott MD

Sharp, Jennie Euteneuer, Jill MD

Simonds, Kadie Ouderkirk, John MD

Simpson, Adrienne Guerdan, Mark DO

Singleton, Sandy Gardner, Alan MD

Smith, Daniel Gutierrez, Raymond MD

Smith, Joni Dunagan, Donnie MD

Sorapuru, Anjenette Andrist, Eric MD

Stanley, Robin Griffith, James MD


MINUTES

JUNE 9, 2016

29

Steinmeyer, Ashleigh Sekul, Elizabeth MD

Stokes, marcid Jurado, Rafael MD

Strickland, Tricia Babalakin, Haolat MD

Sutherland, Joanna Hurd, Thomas MD

Tatman, Hardie Natarajan, Nirupama MD

Thomas, Melissa Womack, Rosalind MD

Tooles, Ronda Thigpen, James MD

Tyler, Christina Collier, Millard MD

Tyler, Christina Andrist, Eric MD

Varghese, Sonia Hoodo, Crystal MD

Waddell, Karen Katragadda, Suneel MD

Walsh, Lisa Griffin, Joseph MD

Wesley, Joanna Lipham, Mark MD

Willard, Brandi Jacobsen, William MD

Williams, Natalie Burke, Michael MD

Williams, Tasheeka Moore, Karen MD

Wilson, Anissa Sharpton, Julian MD

Woughter, Linda Cobiella, Robert MD

The Board determined that the following protocol agreements meet the provisions of

OCGA 43-34-25 with additions/changes:

Alfors, Suzanne Simon, Dawn MD Demott, Jennifer Pallay, Robert MD Mullins, Rodney Murphy, Richard MD Norrell, Jaimi Campbell, Becky MD Shockley, Naiomi Danits, Harvey MD Stephens, Leigh Chronos, Nicolas MD Swift, Lisa Watson, Nancy MD

The Committee recommends to the Board that the following protocol agreement does not meet

the provisions of OCGA 43-34-25 and is TABLED for more information:

Cheeseman, Karen Dutta, Eamon MD

The Board approved the following Other Business items: 1. Approved Melinda Jennings, NP to add Trigger Point and Joint Injections to the agreement

with Dr. Jeremy Statton.

2. Approved Kallayanee Techapatikul, NP to add Nuclear Stress Testing to the agreement with

Dr. Nirag Sharma - with resubmission of Form C with corrected information.

3. Modify Form C to clarify the “APRN CERTIFICATION SPECIALTY” in ALL CAPS SPECIALTY” in ALL CAPS

4. Invite Autumn Lucas to an open position on the NP advisory Committee


MINUTES

JUNE 9, 2016

30

PAIN CLINIC COMMITTEE

Dr. Downey presented the Pain Clinic Committee report as a motion. The motion was seconded by Dr.

Antalis. The Board accepted the report by unanimous vote.


Approve 2 Initial Applications for Licensure

1. File #378 - Coastal Pain and Spine Center. Advise owner they cannot open clinic until

the DEA issues Georgia DEA numbers.

2. File # 384 - PM&R Specialists, PC – Louisville

Approve 2 Change in Location Applications

1. License #380 - Center for Spine and Pain Medicine – Dacula

2. License #266 - Total Diagnostic Interventional Pain (TDI Pain)

Approve selling of 5 medical practices of Pain Solutions Treatment (License #124, 126, 127,

305, 310) to Alliance Spine and Pain Centers for file #379–383 effective 7/15/2016. Owner

must submit signed Bill of Sale prior to licenses being issued.

Approve renewal of license #305 (Canton) and #310 (Hiram) from Pain Solutions Treatment until

7/15/2016, effective date of selling medical practices to Alliance Spine and Pain Centers. After

that date, lapse out the renewal licenses.

Applications Administratively Approved: Approved pending additional information where noted.

License# Pain Clinic Name

124

Pain Solutions Treatment Centers, Inc. – Cartersville

Add APRN Joanne Sutherland

Delete Practicing Physician Virlyn Bishop

Delete Physician Assistant Frankie Davis

Add Physician Assistant Alice Fisher Fazekas

126

Pain Solutions Treatment Centers, Inc. – Marietta





127

Pain Solutions Treatment Centers, Inc. – Woodstock





305

Pain Solutions Treatment Centers, Inc. – Canton






MINUTES

JUNE 9, 2016

31

License# Pain Clinic Name

310

Pain Solutions Treatment Centers, Inc. – Hiram





274

South Atlanta Medical Care

Add APRN Adrienne Simpson

Revise hours of practicing physician Mark Guerdan

120

Southeast Spine Care and Pain Management

Add APRN Kathryn Mori

143

Spine Care and Pain Management – Greensboro

Add APRN Dwayne Taylor

370

Spine Care and Pain Management - Milledgeville

Add APRN Dwayne Taylor

370

Spine Care and Pain Management – Milledgeville

Add practicing physician Olufemi Ogunyemi

239

Lakeside Pain Center

Add APRN Heather Melvin

225

Pain Management Specialists of Atlanta - Stockbridge

Add practicing physician Paul White

Add practicing physician Myung Yoo

Add physician assistant Dana Burch

226

Pain Management Specialists of Atlanta – Griffin

Add practicing physician Ngano Takawira

Add physician assistant Tonya Ogletree

227

Pain Management Specialists of Atlanta – Peachtree City


Add physician assistant Tonya Ogletree

273

Pain Management Specialists of Atlanta – Lithia Springs

Add practicing physician Myung Yo


311

Pain Care, LLC – Newnan

Delete practicing physician David Webb

312

Pain Care, LLC – Stockbridge


313

Pain Care, LLC – Griffin


314

Pain Care, LLC – Fayetteville


234

Specialty Clinics Spine Intervention – Gainesville

Add APRN Ashley Zimmerman

291

Specialty Clinics Spine Intervention – Braselton

Add APRN Ashley Zimmerman

388

Advanced Pain and Rehabilitation

Revise hours practicing physician Lawrence Berman


MINUTES

JUNE 9, 2016

32

Other Business

1. The Committee interviewed LB and CT regarding withdrawal of Marietta Rehabilitation and

Wellness, PC pain application and recommends approving the withdrawal of the application

and to send an agent to the clinic to make sure it is closed.

2. The Committee requested to interview LB on the Marietta issue before making a decision

regarding LB’s request to change the location of Advanced Pain and Rehabilitation (License

#388) and recommends approving the request.

3. The Committee requested that JD come in for an interview regarding the application for

licensure for Marietta Rehabilitation and Wellness, PC. This is the same clinic that LB and

CT recently requested to withdraw. The physician declined to come in for an interview and

requested to withdraw the application. The Committee recommends allowing JD to

withdraw the application and open a case on JD regarding failure to report an arrest on the

initial physician and pain clinic applications.

WELLNESS COMMITTEE

Dr. Powell presented the Wellness Committee report as a motion. The motion was seconded by Dr.

DeLoach. The Board accepted the report by unanimous vote.

1. 20160766: Offer Public CO.

2. PHP report received from Paul Earley, MD

3. 20162053: Table

4. 20121183: Table 30 days.

5. Sandra Chapkowski, MD: Issue Order of Summary Suspension.

6. 20162219: Table 30 days.

INVESTIGATIVE INTERVIEW REPORT

Cami McGarity presented the Investigative Interview report as a motion, and was seconded by

Daniel DeLoach, M.D. The Board accepted the report by unanimous vote. The Board took the

following actions.

20140113 Table 20160806 Further Investigation

20160010 Letter of Concern 20160848 Letter of Concern

20160541 Table 20161176 Close

20160553 Letter of Concern

INVESTIGATIVE COMMITTEE

The Investigative Committee report was presented as a motion by Dr. House and was seconded

by Dr. Antalis. The Board accepted the report by unanimous vote. The Board took the

following actions.

Close:

20140264 20140364 20140699 20141654 20150022 20150316

20150423 20150598 20150685 20150803 20151103 20151394

20160098 20160145 20160265 20160506 20160656 20160708


MINUTES

JUNE 9, 2016

33

20160709 20160821 20160842 20160896 20160913 20160929

20160987 20161010 20161015 20161125 20161173 20161203

20161297 20161298 20161316 20161318 20161351 20161422

20161429 20161446 20161463 20161508 20161513 20161514

20161515 20161516 20161528 20161530 20161535 20161538

20161540 20161573 20161574 20161580 20161581 20161583

20161594 20161598 20161599 20161600 20161615 20161617

20161619 20161627 20161628 20161636 20161637 20161644

20161645 20161648 20161649 20161654 20161949 20161965

20161998 20162021 20162057 20162066 20162124

Close with Letter of Concern:

20141148 20151061 20161063 20161159 20161512 20161524

20161590

Invite for Investigative Interview:

20141364 20150952 20160749 20161339 20161533 20161915

20160130

Further Investigation:

20130270 20141729 20150843 20150940 20160551

OMPE

2060697 20161741

Table

20141060 20160195 20160850 20161216 20161423 20161911 INITIAL COMPLAINT EVALUATIONS

The Board approved the following recommendations.

20160738 20160792 20160813 20161484 20161848 20161863

20161878 20161955 20162004 20162056 20162062 20162065

20162068 20162069 20162070 20162084 20162086 20162107

20162110 20162111 20162114 20162123 20162139 20162146

20162147 20162152 20162153 20162158 20162159 20162163

20162178 20162184 20162185 20162186 20162187 20162188

20162191 20162193 20162195 20162198 20162206 20162207

20162210 20162214 20162225 20162228 20162242 20162251

20162256 20162260 RECUSALS

Antalis 20160806 20161637

Callins 20161010 20161574

DeLoach 20130270 20141364 20150856 20160697 20160709

20161125 20161483 20161516 20161533 20161637

20161949 20162159 20162225

House 20130713 20160929

Marshall 20150856 20161540 20161998 20162056 20162065

20162193

McGarity 20162123

Wallace 20161598

White 20162193


MINUTES

JUNE 9, 2016

34

RULES COMMITTEE

Dr. Gross presented the Rules Committee report as a motion, and was seconded by Dr. DeLoach, The Board accepted the report by unanimous vote. The Board took the following actions.

1. Approved dividing certain sections of the 2016 legislation amongst Board members to assist with

rules.

2. Referred Andrea Wilder from Avenia Behavioral Management to the law regarding telemedicine.

Dr. House submitted a motion, seconded by Dr. Antalis, to adjourn the June 9, 2016 Board meeting at

4:50 p.m. The motion carried unanimously.

____________________________ ________________________________

John Antalis, MD Robert Jeffery, MBA

Chairperson Executive Director

-

Recorded by Phyllis White

Documents

GEORGIA COMPOSITE MEDICAL BOARD · Georgia Composite Medical Board from July 2, ... Wallace and seconded by Ms ... Ms. Wray updated the Board on the status of matter that have been