Physician Compare National (NPI:1700850948)

HEALTHCARE PROVIDER: WILLIAM STEPHEN TANKERSLEY MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1700850948
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3274690805
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090325000574
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TANKERSLEY
	Individual professional last name
Provider First Name	WILLIAM
	Individual professional first name
Provider Middle Name	STEPHEN
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	LOMA LINDA UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1988
	Individual professional's medical school graduation year
Primary Specialty	ORTHOPEDIC SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	TATTNALL HOSPITAL COMPANY LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	6204907124
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	60
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	247 S MAIN ST
	Group Practice or individual's line 1 address
City	REIDSVILLE
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	304534605
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9125571000
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	111323
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	OPTIM MEDICAL CENTER - TATTNALL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	110075
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	EAST GEORGIA REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	111312
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	OPTIM MEDICAL CENTER - SCREVEN
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	110142
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	EVANS MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y