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Physician Onboarding

In order to ensure a smooth transition, please download, complete and return the below forms to:

Elizabeth McCourry, Credentialing and Enrollment Specialist
Phone: 704.671.5326
Fax: 704.671.5308

c/o CMG-Business Service
936 Cox Road
Gastonia, NC 28054

Physician Onboarding Forms:

CMG Signature Log

Credentialing Application

DEA Address Change

Payer Signature

Provider Demographics

Waiver For Claims History