Provider Demographics
NPI:1265541882
Name:SNEAD, HAMPTON LEROY (PA C)
Entity type:Individual
Prefix:
First Name:HAMPTON
Middle Name:LEROY
Last Name:SNEAD
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CARTER PARK DR
Mailing Address - Street 2:SUITE3A
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-1152
Mailing Address - Country:US
Mailing Address - Phone:864-885-0058
Mailing Address - Fax:864-885-0098
Practice Address - Street 1:109 CARTER PARK DR
Practice Address - Street 2:SUITE 3A
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-1152
Practice Address - Country:US
Practice Address - Phone:864-885-0058
Practice Address - Fax:864-885-0098
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA755363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P20726Medicare UPIN
SC3968Medicare ID - Type Unspecified