Healthcare Provider Details

I. General information

NPI: 1427184845
Provider Name (Legal Business Name): MOBILERAY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1886 GOLA DR
FAYETTEVILLE NC
28301-0522
US

IV. Provider business mailing address

1886 GOLA DR
FAYETTEVILLE NC
28301-0522
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-7752
  • Fax: 910-221-7037
Mailing address:
  • Phone: 910-488-7752
  • Fax: 910-221-7037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number285746
License Number StateNC

VIII. Authorized Official

Name: MR. EMERY EARLE GIBBS
Title or Position: CHEIF OF OPERATIONS
Credential: RT-R
Phone: 910-488-7752