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General NPI Number Information
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NPI Number | 1043967268
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Entity Type | Organization
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Legal Business Name | SIDCORP LLC
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Dates
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Enumeration Date | 03/08/2022
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 5575 N POINT PKWY STE 32
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City | ALPHARETTA
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State | GA
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Zip | 30022
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Country | US
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Telephone | 770-467-3975
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Fax |
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Provider Business Mailing Address
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Address Line | 5755 N POINT PKWY STE 32
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City | ALPHARETTA
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State | GA
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Zip | 30022-1143
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Country | US
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Telephone | 770-467-3975
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. NICK SIDHU
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Credential | MD
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Telephone | 770-467-3975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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