Request an Appointment One of our schedulers will contact you to confirm your time. Need to schedule and confirm immediately? Please call us at 770-914-1808 so that we can assist you. Who is this appointment for?Patient’s First Name*Patient’s Last Name*Date of Birth Email Address* Phone Number*Where does the patient live?Street Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code What can we help you with?What do you need to be seen for?*Which provider would you like to see?Preferred ProviderNo PreferenceAshly Joseph, M.D.Muhammad Faisal Siddiqui, M.D.Tamika Johnnicans, FNP-CWhat insurance will you use? Enter Insurance ProviderOR The patient does NOT have health insurance When would you like to come in?Requested Date Requested TimeSelect TimeMorningAfternoonFirst AvailableAnything else we should know?Additional CommentsNameThis field is for validation purposes and should be left unchanged.