STATTESBORO ORTHOPAEDIC CENTER, INC (NPI# 1760627699) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760627699 |
| Entity Type | Organization |
| Organization Name | STATTESBORO ORTHOPAEDIC CENTER, INC |
| Other Organization Name | COASTAL ORTHOPEDICS AND SPORTS MEDICINE SPECIALISTS |
| Practice Address |
1497 Fair Rd Ste 101 Statesboro GA 30458-0823 |
| Practice Telephone | 9122253760 |
| Practice Fax Number | 9122253767 |
| Mailing Telephone | 9122253760 |
| Mailing Fax Number | 9122253767 |
| Enumeration Date | 2008-12-05 |
| Last Update Date | 2012-04-26 |
| Authorized Official Name | WILLIAM STEPHEN TANKERSLEY (MD-OWNER) |
| Authorized Official Telephone | 9122253760 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207XS0114X |
Orthopaedic Surgery Specialization: Adult Reconstructive Orthopaedic Surgery |
034484 | GA | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| Y | 207X00000X | Orthopaedic Surgery | 034484 | GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Coastal Orthopedics and Sports Medicine Specialists | Former Legal Business Name - Organization |
| Street Address |
1497 FAIR RD STE 101 |
| City | STATESBORO |
| State | GA |
| Zip Code | 30458-0823 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952380768 | Karen Renea Hilde | Nurse Practitioner | 1497 Fair Rd, Suite 200, Statesboro, GA 30458-0822 | 2006-01-10 |
| 1508393208 | Neurology and Neurodiagnostic LLC | Psychiatry & Neurology | 1497 Fair Rd, Statesboro, GA 30458-0822 | 2017-05-12 |
| 1720341514 | Bulloch Pediatrics Group, LLC | Nurse Practitioner | 1497 Fair Rd, Suite 200, Statesboro, GA 30458-0822 | 2012-06-18 |
| 1114291051 | Clare D Heidler Iv | Registered Nurse | 1497 Fair Rd, Suite 102, Statesboro, GA 30458-0822 | 2012-02-23 |
| 1942591482 | Kathryn Winn Marucco | Nurse Practitioner | 1497 Fair Rd, Suite 200, Statesboro, GA 30458-0822 | 2011-05-02 |
| 1487983151 | East Georgia Hma Physician Management, LLC | Surgery | 1497 Fair Rd, Statesboro, GA 30458-0822 | 2009-12-09 |
| 1023247723 | Ian C Munger | Emergency Medicine | 1497 Fair Rd, Statesboro, GA 30458-0822 | 2009-07-02 |
| 1679775712 | Bulloch Pediatrics, PC | Pediatrics | 1497 Fair Rd, Ste 200, Statesboro, GA 30458-0822 | 2007-06-01 |
| 1043352958 | Cesar Clinic, LLC | Specialist | 1497 Fair Rd, Suite 201, Statesboro, GA 30458-0822 | 2007-02-14 |
| 1700947231 | Kashyap Patel | Psychiatry & Neurology | 1497 Fair Rd, Suite 201, Statesboro, GA 30458-0822 | 2006-12-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639642218 | Youtherapy | Counselor | 430 Northside Dr East, Suite 160 Mb326, Statesboro, GA 30458 | 2019-01-07 |
| 1053891853 | Alexandria Franklin | Specialist/Technologist | 1332 Southern Dr, Statesboro, GA 30458 | 2018-08-21 |
| 1740780006 | Michael Ryan Clark | Pharmacist | 556 Northside Drive, Statesboro, GA 30458 | 2018-02-13 |
| 1689186405 | Chandler James Herman | Specialist/Technologist | 590 Herty Dr., Statesboro, GA 30458 | 2017-11-02 |
| 1477009181 | Mama Doc Pediatrics, LLC | Pediatrics | 400 East Grady Street, Statesboro, GA 30458 | 2016-09-01 |
| 1053761171 | Rebekah Roessler | Specialist/Technologist | 2687 Akins Blvd, Statesboro, GA 30458 | 2016-06-20 |
| 1427412253 | Refocus Counseling and Consulting Services | Community/Behavioral Health | 4325 Country Club, 4, Statesboro, GA 30458 | 2016-04-07 |
| 1023408523 | Kacy H. Nesmith | Nurse Practitioner | 1098 Bermuda Run, Suite 6, Statesboro, GA 30458 | 2015-02-04 |
| 1760870398 | Jessica Pasternack | Specialist/Technologist | 2687 Akins Boulevard, Statesboro, GA 30458 | 2015-01-06 |
| 1922401629 | Nathan D'amico | Student in an Organized Health Care Education/Training Program | 15 W Grady Street Unit A, Statesboro, GA 30458 | 2014-10-08 |
| Find all providers in zip 30458 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346510542 | Jenkins County Hospital LLC | Orthopaedic Surgery | 16915 Hwy 27 South, Suite A, Statesboro, GA 30458 | 2012-01-04 |
| 1770809170 | Frederick Matthew Laun | Orthopaedic Surgery | 102 Turkey Trail, Statesboro, GA 30458-0328 | 2010-04-12 |
| 1700850948 | William Stephen Tankersley | Orthopaedic Surgery | 16915 Highway 67 South, Suite A, Statesboro, GA 30458 | 2006-02-15 |
| 1801280664 | Optim Orthopedics, LLC | Orthopaedic Surgery | 16915 Highway 67, Suite A, Statesboro, GA 30458-5819 | 2015-03-19 |
| 1598033102 | Tattnall Hospital Company LLC | Orthopaedic Surgery | 16915 Highway 67, Suite A, Statesboro, GA 30458-5819 | 2011-12-09 |
| 1790786820 | Kenneth Allan Johnson | Orthopaedic Surgery | 1601 Fair Rd, Suite 300, Statesboro, GA 30458-1698 | 2005-08-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790386258 | Thrive Orthopaedics LLC | Orthopaedic Surgery | 5775 Peachtree Dunwoody Rd Ne Ste C150a, Atlanta, GA 30342-1501 | 2020-11-02 |
| 1568061000 | Esrpa | Orthopaedic Surgery | 1717 Benhill Dr, Snellville, GA 30078-2595 | 2020-10-24 |
| 1588273122 | Mallory Mary Garretson | Orthopaedic Surgery | 3240 N E Expy Ne Ste 100, Atlanta, GA 30341-4003 | 2020-07-29 |
| 1982248597 | Atlanta Area Orthopedics and Regenerative Medicine LLC | Orthopaedic Surgery | 2878 Five Forks Trickum Rd Ste 2c, Lawrenceville, GA 30044-5896 | 2019-11-06 |
| 1821639758 | Optim Orthopedics, LLC | Orthopaedic Surgery | 586 Islands Hwy, Midway, GA 31320-5962 | 2019-10-02 |
| 1396306197 | Athens Orthopedic Clinic, Pa | Orthopaedic Surgery | 1000 Cowles Clinic Way Ste A-400, Greensboro, GA 30642-5289 | 2019-06-24 |
| 1588121123 | 2019 Coastal Orthopedics Surgical Assist LLC | Orthopaedic Surgery | 8882 Abercorn St, Savannah, GA 31406-4508 | 2019-03-01 |
| 1386108769 | Focus Orthopaedics and Sports Medicine PC | Orthopaedic Surgery | 642 Hospital Rd, Commerce, GA 30529-1142 | 2019-01-30 |
| 1326523572 | Athens Orthopedic Clinic, Pa | Orthopaedic Surgery | 2108 Teron Trce Ste 100, Dacula, GA 30019-1666 | 2018-10-03 |
| 1831670322 | Performance Orthopaedics & Sports Medicine | Orthopaedic Surgery | 755 Mount Vernon Hwy Ne Ste 305, Atlanta, GA 30328-4274 | 2018-08-23 |
| Find all providers with the same taxonomy | ||||
| City | STATESBORO |
| Zip Code | 30458 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.