Healthcare Provider Details

I. General information

NPI: 1467651711
Provider Name (Legal Business Name): CHARLES FREDERICK DEGENHARDT III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 WATERS AVE
SAVANNAH GA
31404
US

IV. Provider business mailing address

5400 WATERS AVE
SAVANNAH GA
31404-6234
US

V. Phone/Fax

Practice location:
  • Phone: 912-349-4227
  • Fax: 912-349-4457
Mailing address:
  • Phone: 912-349-4227
  • Fax: 912-349-4457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 106894
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL29799
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberTL34875
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number70547
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: