1700850948 NPI number — WILLIAM STEPHEN TANKERSLEY MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700850948 NPI number — WILLIAM STEPHEN TANKERSLEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANKERSLEY
Provider First Name:
WILLIAM
Provider Middle Name:
STEPHEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TANKERSLEY
Provider Other First Name:
WILLIAM
Provider Other Middle Name:
STEPHEN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1700850948
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 EAST DERENNE AVE
Provider Second Line Business Mailing Address:
ATTN- PROVIDER ENROLLMENT
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-644-5300
Provider Business Mailing Address Fax Number:
912-644-5260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16915 HIGHWAY 67 SOUTH
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
STATESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-681-2500
Provider Business Practice Location Address Fax Number:
912-681-2025
Provider Enumeration Date:
02/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  034484 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0942075 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31743 . This is a "PARTNERS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5374830002 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 23258 . This is a "PRINCIPAL HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8912043 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0382260001 . This is a "DMERC MEDICARE SUPPLIES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200036693 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89026 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 53003473 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2167312 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 380326550B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12043 . This is a "BCBS OF NC" identifier . This identifiers is of the category "OTHER".




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