Gonzalo Mantilla, M.D.

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

License

ME 22858 Issued in FL

Practice address

777 Franklin Gtwy SE
Marietta, GA 30067-7803

Phone

(770) 732-6007

NPI assigned

Jul 12, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nnokp

  • Pediatric Nurse Practitioner
  • Marietta, GA
  • NPI 1932648730
  NPD (past)
• Nuestros Ninos Our Kids Pediatrics Inc.

  • Pediatric Nurse Practitioner
  • Marietta, GA
  • NPI 1972756732
  NPD (past)
• University Medical Service Association Inc

  • Durable Medical Equipment & Medical Supplies
  • Tampa, FL
  • NPI 1194276576
  NPD (past)

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684368000000",
    "number": "1629076799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 FRANKLIN GTWY SE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300677803",
            "telephone_number": "770-732-6007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 FRANKLIN GTWY SE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300677803",
            "telephone_number": "770-732-6007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTILLA",
        "first_name": "GONZALO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "FL",
            "license": "ME 22858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "10926",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Manor Care of Marietta Ga, LLC
• Mukanda Mamie-Celine Manseka, FNP
• Muhammad Sohail Mansoor, M.D.
• Aya Haseeb Mansour, PA
• Anahita Mansouri, MD
• April Lashawn Manuel, NP
• Marissa Anne Manuel, NP
• Alisa J Manulkin, PHD
• Carolina Manzano, RBT
• Yumei Manzano, PA-C

• Neonatal-Perinatal Medicine Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Neonatal-Perinatal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.