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General NPI Number Information
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NPI Number | 1760627699
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Entity Type | Organization
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Legal Business Name | STATTESBORO ORTHOPAEDIC CENTER, INC
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Dates
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Enumeration Date | 12/05/2008
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 1497 FAIR RD STE 101
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City | STATESBORO
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State | GA
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Zip | 30458-0823
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Country | US
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Telephone | 912-225-3760
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Fax | 912-225-3767
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Provider Business Mailing Address
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Address Line | 1497 FAIR RD STE 101
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City | STATESBORO
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State | GA
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Zip | 30458-0823
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Country | US
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Telephone | 912-225-3760
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Fax | 912-225-3767
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Authorized Official
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Title or Position | MD-OWNER
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Name | WILLIAM STEPHEN TANKERSLEY
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Credential | M.D.
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Telephone | 912-225-3760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 034484
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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