MEDICARE: SIDCORP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician
2	207RA0401X	Addiction Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1043967268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIDCORP LLC

Provider Business Mailing Address
First Line	:	5755 N POINT PKWY STE 32
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30022-1143
Country	:	US
Telephone Number	:	770-467-3975
Fax Number	:

Provider Business Practice Location Address
First Line	:	5575 N POINT PKWY STE 32
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30022
Country	:	US
Telephone Number	:	770-467-3975
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. NICK SIDHU
Credential	:	MD
Telephone Number	:	770-467-3975

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	02/09/2026

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