Healthcare Provider Details

I. General information

NPI: 1497484182
Provider Name (Legal Business Name): ANDY SACKEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 RANDOLPH RD STE 100
CHARLOTTE NC
28211-1365
US

IV. Provider business mailing address

3030 RANDOLPH RD STE 100
CHARLOTTE NC
28211-1365
US

V. Phone/Fax

Practice location:
  • Phone: 704-512-4450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2026-03850
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: