Organization Active NPI

Gastroenterology Medicine & Nutrition Clinic, PC

  • Gastroenterology Physician
  • Atlanta, GA
National Provider Identifier
1366625535
Registry record updated Jun 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
021539 Issued in GA
Legal business name
GASTROENTEROLOGY MEDICINE & NUTRITION CLINIC, PC
Practice address
3886 Princeton Lakes Way SW Ste 120
Atlanta, GA 30331-5511
Phone
(404) 681-0000
Fax
(678) 866-2538
NPI assigned
Dec 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Edward A Layne, M.D.NPI 1891807434
Title
President
Phone
(404) 681-0000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X 021539 GA Primary
Medical Specialty Clinic/Center 261QM2500X 021539 GA

Addresses

Primary practice location

3886 Princeton Lakes Way SW Ste 120
Atlanta, GA 30331-5511

Mailing address

PO Box 570744
Atlanta, GA 30357-3113
Phone (404) 681-0000

Other practice location 1

3200 Downwood Cir NW Ste 340
Atlanta, GA 30327-1605
Phone (404) 681-0000

Other identifiers 1

IdentifierTypeStateIssuer
00204586BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090702000038 GA Part B Supplier - Clinic/Group Practice 1759432784 Receives reassigned benefits from 1 practitioner
Practice locations: Smyrna, GA; Smyre, GA; Atlanta, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2336509Gastroenterology & Nutrition Clinics3886 Princeton Lakes Way, Suite 120, Atlanta, GA 30331Certificate of waiverJan 5, 2028

National Provider Directory

National Provider Directory

Locations

3040 Highlands Pkwy SE
Ste C
Smyrna, GA 30082
Phone (404) 681-0000

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749686400000",
    "number": "1366625535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 570744",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303573113",
            "telephone_number": "404-681-0000",
            "fax_number": "404-365-8354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3886 PRINCETON LAKES WAY SW STE 120",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303315511",
            "telephone_number": "404-681-0000",
            "fax_number": "678-866-2538"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 Downwood Cir NW Ste 340",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303271605",
            "country_code": "US",
            "telephone_number": "404-681-0000",
            "fax_number": "404-365-8354",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GASTROENTEROLOGY MEDICINE & NUTRITION CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-11",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A",
        "authorized_official_last_name": "LAYNE",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-681-0000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "GA",
            "license": "021539",
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "GA",
            "license": "021539",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00204586B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.