Healthcare Provider Details

I. General information

NPI: 1821612292
Provider Name (Legal Business Name): SARAH PARDUE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 PEACHTREE LN
ADVANCE NC
27006-6753
US

IV. Provider business mailing address

147 PEACHTREE LN
ADVANCE NC
27006-6753
US

V. Phone/Fax

Practice location:
  • Phone: 336-713-2290
  • Fax: 336-713-2240
Mailing address:
  • Phone: 336-713-2290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2023-02487
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: