Healthcare Provider Details

I. General information

NPI: 1740670199
Provider Name (Legal Business Name): ANDREW NIDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 PREMIER DR STE 307
HIGH POINT NC
27265-8356
US

IV. Provider business mailing address

4515 PREMIER DR STE 307
HIGH POINT NC
27265-8356
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2250
  • Fax: 336-881-3890
Mailing address:
  • Phone: 336-802-2250
  • Fax: 336-881-3890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001005535
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: