Individual
DR. NATHALIE MANTILLA FARFAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
1348 WALTON WAY STE 6500, AUGUSTA, GA 30901-5111
(706) 722-2118
Mailing address
1130 S MICHIGAN AVE APT 3104, CHICAGO, IL 60605-2322
(312) 927-5299
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036140788
IL
208C00000X
Colon & Rectal Surgery Physician
036140788
IL
208C00000X
Colon & Rectal Surgery Physician
Primary
101399
GA
Other
Enumeration date
04/06/2010
Last updated
11/06/2024
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