Organization
GASTROENTEROLOGY MEDICINE & NUTRITION CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD A LAYNE M.D. (PRESIDENT)
(404) 681-0000
Entity
Organization
Contact information
Practice address
3886 PRINCETON LAKES WAY SW STE 120, ATLANTA, GA 30331-5511
(404) 681-0000
(678) 866-2538
Mailing address
PO BOX 570744, ATLANTA, GA 30357-3113
(404) 681-0000
(404) 365-8354
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
021539
GA
261QM2500X
Medical Specialty Clinic/Center
021539
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00204586B
—
GA
Enumeration date
12/11/2007
Last updated
06/12/2025
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