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General NPI Number Information
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NPI Number | 1700850948
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Entity Type | Individual
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Provider Name | WILLIAM STEPHEN TANKERSLEY MD
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Gender | Male
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 16915 HIGHWAY 67 SOUTH SUITE A
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City | STATESBORO
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State | GA
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Zip | 30458
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Country | US
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Telephone | 912-681-2500
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Fax | 912-681-2025
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Provider Business Mailing Address
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Address Line | 210 EAST DERENNE AVE ATTN- PROVIDER ENROLLMENT
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City | SAVANNAH
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State | GA
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Zip | 31405
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Country | US
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Telephone | 912-644-5300
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Fax | 912-644-5260
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 034484
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License Number State | GA
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