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Contact Information

GASTROENTEROLOGY MEDICINE & NUTRITION CLINIC, PC
3886 PRINCETON LAKES WAY SW STE 120
ATLANTA, GA30331-5511
 Phone: 404-681-0000
 Fax: 678-866-2538
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Gastroenterology

207RG0100X 10 Physician/Gastroenterology
 

Medical Specialty

261QM2500X
Indicates primary specialty

NPI Profile & details for GASTROENTEROLOGY MEDICINE & NUTRITION CLINIC, PC

NPI # 1366625535
LBN Legal business name GASTROENTEROLOGY MEDICINE & NUTRITION CLINIC, PC
Authorized official EDWARD LAYNE - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 12/11/2007
Last updated 06/12/2025 - About 12 months ago
Identifiers
GA License # 021539
GA Medicaid 00204586B
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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