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Individual

ZACHARY MANTOOTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
APRN

Contact information

Practice address
6439 GARNERS FERRY RD, COLUMBIA, SC 29209-1638
(803) 776-4000
Mailing address
6439 GARNERS FERRY RD, COLUMBIA, SC 29209-1638
(803) 776-4000

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
19305
SC
363LG0600X
Gerontology Nurse Practitioner
19305
SC

Other

Enumeration date
04/01/2015
Last updated
04/01/2015
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