# GASTROENTEROLOGY MEDICINE & NUTRITION CLINIC, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366625535
- **Authorized official:** DR. EDWARD A LAYNE M.D. (PRESIDENT)
- **Authorized official phone:** (404) 681-0000

## Contact information

- **Practice address:** 3886 PRINCETON LAKES WAY SW STE 120, ATLANTA, GA 30331-5511
- **Practice address phone:** (404) 681-0000
- **Practice address fax:** (678) 866-2538
- **Mailing address:** PO BOX 570744, ATLANTA, GA 30357-3113
- **Mailing address phone:** (404) 681-0000
- **Mailing address fax:** (404) 365-8354

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | 021539 | GA | Yes |
| 261QM2500X | Medical Specialty Clinic/Center | 021539 | GA | — |

## Other

- **Enumeration date:** 12/11/2007
- **Last updated:** 06/12/2025