NPIMap

Organization Active NPI

Gastrointestinal Diagnostic Endoscopy Woodstock, LLC

Doing business as Town Lake Endoscopy Center

  • Ambulatory Surgical Clinic/Center
  • Woodstock, GA
National Provider Identifier
1760778765
Registry record updated Dec 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
028-451 Issued in GA
Legal business name
GASTROINTESTINAL DIAGNOSTIC ENDOSCOPY WOODSTOCK, LLC
Doing business as
Town Lake Endoscopy Center
Practice address
118 Mill St Ste 100
Woodstock, GA 30188-4880
Phone
(770) 226-9070
Fax
(770) 226-8863
NPI assigned
Jun 28, 2011
Last updated
Dec 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2025

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

Authorized official

Name
Tracy L Jones
Title
Practice Administration
Phone
(678) 741-2317

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 028-451 GA Primary
Endoscopy Clinic/Center 261QE0800X NU

Addresses

Primary practice location

118 Mill St Ste 100
Woodstock, GA 30188-4880

Mailing address

2550 Windy Hill Rd SE Ste 302
Marietta, GA 30067-8655
Phone (678) 741-5000

Other names 1

  • Town Lake Endoscopy Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110926000843 GA Part B Supplier - Ambulatory Surgical Center 3072784966 Receives reassigned benefits from 1 practitioner
Practice locations: Woodstock, GA

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Gastrointestinal Diagnostic Endoscopy Woodstock LLCCCN 11C0001379
Medicare certification status
ActiveFrom the Provider of Services file

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
11D2029444Gastrointestinal Diagnostic Endoscopy Woodstock,118 Mill Street, Suite 100, Woodstock, GA 30188Certificate of waiverSep 7, 2027

National Provider Directory

National Provider Directory

Locations

880 Crestmark Dr
Ste 102
Lithia Springs, GA 30122
Phone (678) 388-2040

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1309219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764720000000",
    "number": "1760778765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 WINDY HILL RD SE STE 302",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300678655",
            "telephone_number": "678-741-5000",
            "fax_number": "678-741-2301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 MILL ST STE 100",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301884880",
            "telephone_number": "770-226-9070",
            "fax_number": "770-226-8863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROINTESTINAL DIAGNOSTIC ENDOSCOPY WOODSTOCK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-28",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATION",
        "authorized_official_telephone_number": "678-741-2317"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "028-451",
            "primary": true
        },
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Town Lake Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodstock, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 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.