Individual
DR. GONZALO MANTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
777 FRANKLIN GTWY SE, MARIETTA, GA 30067-7803
(770) 732-6007
Mailing address
777 FRANKLIN GTWY SE, MARIETTA, GA 30067-7803
(770) 732-6007
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
ME 22858
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10926
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/12/2005
Last updated
05/18/2023
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