Provider Demographics
NPI:1700850948
Name:TANKERSLEY, WILLIAM STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:STEPHEN
Last Name:TANKERSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:STEPHEN
Other - Last Name:TANKERSLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:210 EAST DERENNE AVE
Mailing Address - Street 2:ATTN- PROVIDER ENROLLMENT
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:16915 HIGHWAY 67 SOUTH
Practice Address - Street 2:SUITE A
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458
Practice Address - Country:US
Practice Address - Phone:912-681-2500
Practice Address - Fax:912-681-2025
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034484207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0942075OtherUNITED HEALTHCARE
31743OtherPARTNERS MEDICARE
5374830002OtherCIGNA HEALTHCARE
23258OtherPRINCIPAL HEALTHCARE
NC8912043Medicaid
0382260001OtherDMERC MEDICARE SUPPLIES
200036693OtherRAILROAD MEDICARE
89026OtherMEDCOST
53003473OtherAETNA
2167312OtherAETNA US HEALTHCARE
GA380326550BMedicaid
12043OtherBCBS OF NC
GA380326550BMedicaid
NC8912043Medicaid