| Gastroenterology Medicine & Nutrition Clinic, Pc | |
|
3200 Downwood Cir Nw Ste 340 Atlanta GA 30327-1605 | |
| (404) 681-0000 | |
| (404) 365-8354 |
| Full Name | Gastroenterology Medicine & Nutrition Clinic, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3200 Downwood Cir Nw Ste 340, Atlanta, Georgia |
| Authorized Official Name and Position | Edward A Layne (PRESIDENT) |
| Authorized Official Contact | 4046810000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gastroenterology Medicine & Nutrition Clinic, Pc Po Box 77007 Atlanta GA 30357-1007 Ph: (404) 681-0000 | Gastroenterology Medicine & Nutrition Clinic, Pc 3200 Downwood Cir Nw Ste 340 Atlanta GA 30327-1605 Ph: (404) 681-0000 |
| NPI Number | 1366625535 |
|---|---|
| Provider Enumeration Date | 12/11/2007 |
| Last Update Date | 07/07/2008 |
| Medicare PECOS PAC ID | 1759432784 |
|---|---|
| Medicare Enrollment ID | O20090702000038 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366625535 | NPI | - | NPPES |
| 00204586B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 021539 (Georgia) | Primary |
| 261QM2500X | Clinic/center - Medical Specialty | 021539 (Georgia) | Secondary |
| Provider Name | Edward A Layne |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1891807434 PECOS PAC ID: 1951361575 Enrollment ID: I20041018000467 |
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