Provider Demographics
NPI:1225908643
Name:FULLSCOPE MOBILE DIAGNOSTICS
Entity type:Organization
Organization Name:FULLSCOPE MOBILE DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-722-3648
Mailing Address - Street 1:330 LEVINE RD
Mailing Address - Street 2:
Mailing Address - City:ODENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35120-3607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 LEVINE RD
Practice Address - Street 2:
Practice Address - City:ODENVILLE
Practice Address - State:AL
Practice Address - Zip Code:35120-3607
Practice Address - Country:US
Practice Address - Phone:205-722-3648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-10
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyGroup - Single Specialty