NPIMap

Organization Active NPI

Stattesboro Orthopaedic Center, Inc

  • Orthopaedic Surgery Physician
  • Statesboro, GA
National Provider Identifier
1760627699
Registry record updated Apr 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
034484 Issued in GA
Legal business name
STATTESBORO ORTHOPAEDIC CENTER, INC
Practice address
1497 Fair Rd
Ste 101
Statesboro, GA 30458-0823
Phone
(912) 225-3760
Fax
(912) 225-3767
NPI assigned
Dec 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William Stephen Tankersley, M.D.
Title
MD-Owner
Phone
(912) 225-3760

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207X00000X 034484 GA Primary
Orthopaedic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207X00000X
Adult Reconstructive Orthopaedic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207XS0114X 034484 GA

Addresses

Primary practice location

1497 Fair Rd
Ste 101
Statesboro, GA 30458-0823

Mailing address

1497 Fair Rd
Ste 101
Statesboro, GA 30458-0823
Phone (912) 225-3760

Other names 1

  • Coastal Orthopedics and Sports Medicine Specialists Former legal business name

National Provider Directory

National Provider Directory

Locations

1497 Fair Rd
Ste 101
Statesboro, GA 30458
Phone (912) 225-3760

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335398400000",
    "number": "1760627699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1497 FAIR RD",
            "address_2": "STE 101",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580823",
            "telephone_number": "912-225-3760",
            "fax_number": "912-225-3767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1497 FAIR RD",
            "address_2": "STE 101",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580823",
            "telephone_number": "912-225-3760",
            "fax_number": "912-225-3767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATTESBORO ORTHOPAEDIC CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-05",
        "last_updated": "2012-04-26",
        "status": "A",
        "authorized_official_last_name": "TANKERSLEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "STEPHEN",
        "authorized_official_title_or_position": "MD-OWNER",
        "authorized_official_telephone_number": "912-225-3760",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "GA",
            "license": "034484",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "GA",
            "license": "034484",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Orthopedics and Sports Medicine Specialists",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Statesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.