NPI Code Detail JSON Logo

1760627699 NPI number — STATTESBORO ORTHOPAEDIC CENTER, INC

NPI Number: 1760627699
Health Care Provider/Practitioner: STATTESBORO ORTHOPAEDIC CENTER, INC

Information about “1760627699” NPI (STATTESBORO ORTHOPAEDIC CENTER, INC) exists in 1760627699 in HTML format HTML  |  1760627699 in plain Text format TXT  |  1760627699 in PDF (Portable Document Format) PDF  |  1760627699 in an XML format XML  formats.

NPI Number : 1760627699 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760627699",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "STATTESBORO ORTHOPAEDIC CENTER, INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1497 FAIR RD",
    "SecondLineMailingAddress": "STE 101",
    "MailingAddressCityName": "STATESBORO",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30458-0823",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "912-225-3760",
    "MailingAddressFaxNumber": "912-225-3767",
    "FirstLinePracticeLocationAddress": "1497 FAIR RD",
    "SecondLinePracticeLocationAddress": "STE 101",
    "PracticeLocationAddressCityName": "STATESBORO",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30458-0823",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "912-225-3760",
    "PracticeLocationAddressFaxNumber": "912-225-3767",
    "EnumerationDate": "12/05/2008",
    "LastUpdateDate": "04/26/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "TANKERSLEY",
    "AuthorizedOfficialFirstName": "WILLIAM",
    "AuthorizedOfficialMiddleName": "STEPHEN",
    "AuthorizedOfficialTitle": "MD-OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "912-225-3760",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207XS0114X",
          "TaxonomyName": "Adult Reconstructive Orthopaedic Surgery Physician",
          "LicenseNumber": "034484",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207X00000X",
          "TaxonomyName": "Orthopaedic Surgery Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207X00000X",
          "TaxonomyName": "Orthopaedic Surgery Physician",
          "LicenseNumber": "034484",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.