Provider Demographics
NPI:1013492180
Name:PENDERGRAFT, SAMUEL SPARROW (PHD, PA-C)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:SPARROW
Last Name:PENDERGRAFT
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Gender:M
Credentials:PHD, PA-C
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Mailing Address - Street 1:1900 W PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3563
Mailing Address - Country:US
Mailing Address - Phone:336-903-6920
Mailing Address - Fax:336-903-6921
Practice Address - Street 1:1900 W PARK DR STE C
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3563
Practice Address - Country:US
Practice Address - Phone:336-903-6920
Practice Address - Fax:336-903-6921
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2022-02-08
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Provider Licenses
StateLicense IDTaxonomies
NC0010-08261363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant