Provider Demographics
NPI:1467651711
Name:DEGENHARDT, CHARLES FREDERICK III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:FREDERICK
Last Name:DEGENHARDT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6234
Mailing Address - Country:US
Mailing Address - Phone:912-349-4227
Mailing Address - Fax:912-349-4457
Practice Address - Street 1:5400 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-349-4227
Practice Address - Fax:912-349-4457
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL29799207R00000X
FLME 106894207R00000X
SCTL34875207RR0500X
GA70547207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL34875OtherSTATE LICENSE
GA70547OtherSTATE MEDICAL LICENSES