Healthcare Provider Details

I. General information

NPI: 1043967268
Provider Name (Legal Business Name): SIDCORP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 N POINT PKWY STE 32
ALPHARETTA GA
30022
US

IV. Provider business mailing address

5755 N POINT PKWY STE 32
ALPHARETTA GA
30022-1143
US

V. Phone/Fax

Practice location:
  • Phone: 770-467-3975
  • Fax:
Mailing address:
  • Phone: 770-467-3975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NICK SIDHU
Title or Position: PHYSICIAN
Credential: MD
Phone: 770-467-3975