Organization
STATTESBORO ORTHOPAEDIC CENTER, INC
Active
Other names
Coastal Orthopedics and Sports Medicine Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM STEPHEN TANKERSLEY M.D. (MD-OWNER)
(912) 225-3760
Entity
Organization
Contact information
Practice address
1497 FAIR RD, STE 101, STATESBORO, GA 30458-0823
(912) 225-3760
(912) 225-3767
Mailing address
1497 FAIR RD, STE 101, STATESBORO, GA 30458-0823
(912) 225-3760
(912) 225-3767
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
034484
GA
207X00000X
Orthopaedic Surgery Physician
—
—
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
034484
GA
Other
Enumeration date
12/05/2008
Last updated
04/26/2012
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