1700850948 NPI number — WILLIAM STEPHEN TANKERSLEY MD

Table of content: JASMINE ROSE ESSA PA-C (NPI 1437031564)

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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