Provider Demographics
NPI:1699714139
Name:DEGENHART, WILLIAM J (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:DEGENHART
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-8543
Mailing Address - Country:US
Mailing Address - Phone:912-354-4800
Mailing Address - Fax:912-629-5821
Practice Address - Street 1:4720 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6292
Practice Address - Country:US
Practice Address - Phone:912-354-4800
Practice Address - Fax:912-659-5821
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022538207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000222296DOtherMEDICAID - SAVANNAH
GA000222296EOtherMEDICAID - STATESBORO
GA000222296IOtherMEDICAID - RINCON
GA000222296JOtherMEDICAID - RICHMOND HILL
GA000222296KOtherMEDICAID- SAVANNAH
GA1699714139OtherMEDICARE RAILROAD
SCG22538Medicaid
GA511G701032OtherGA MEDICARE GROUP
GA10053819OtherAMERIGROUP
GA000222296LOtherMEDICAID - STATESBORO
GA349746OtherWELLCARE OF GA
SCGPA977OtherMEDICAID GRP. SAV
GA000222296MOtherMEDICAID - RINCON
SCGPA977OtherMEDICAID GRP. SAV
SCG22538Medicaid
GA0412940004Medicare NSC
GA0412940007Medicare NSC
GA000222296KOtherMEDICAID- SAVANNAH
GA18BDCLLMedicare PIN
GA000222296DOtherMEDICAID - SAVANNAH
GA000222296IOtherMEDICAID - RINCON
GA000222296LOtherMEDICAID - STATESBORO
GA000222296MOtherMEDICAID - RINCON
GA0412940002Medicare NSC