Basic Information
| Provider Information | |||||||||
| NPI: | 1700850948 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TANKERSLEY | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | STEPHEN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TANKERSLEY | ||||||||
| OtherFirstName: | WILLIAM | ||||||||
| OtherMiddleName: | STEPHEN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 210 EAST DERENNE AVE | ||||||||
| Address2: | ATTN- PROVIDER ENROLLMENT | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126445300 | ||||||||
| FaxNumber: | 9126445260 | ||||||||
| Practice Location | |||||||||
| Address1: | 16915 HIGHWAY 67 SOUTH | ||||||||
| Address2: | SUITE A | ||||||||
| City: | STATESBORO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126812500 | ||||||||
| FaxNumber: | 9126812025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 01/14/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 034484 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0942075 | 01 | UNITED HEALTHCARE | OTHER | 31743 | 01 | PARTNERS MEDICARE | OTHER | 5374830002 | 01 | CIGNA HEALTHCARE | OTHER | 23258 | 01 | PRINCIPAL HEALTHCARE | OTHER | 8912043 | 05 | NC | MEDICAID | 0382260001 | 01 | DMERC MEDICARE SUPPLIES | OTHER | 200036693 | 01 | RAILROAD MEDICARE | OTHER | 89026 | 01 | MEDCOST | OTHER | 53003473 | 01 | AETNA | OTHER | 2167312 | 01 | AETNA US HEALTHCARE | OTHER | 380326550B | 05 | GA | MEDICAID | 12043 | 01 | BCBS OF NC | OTHER |