Healthcare Provider Details

I. General information

NPI: 1023357464
Provider Name (Legal Business Name): BOOKER ORAL SURGERY & IMPLANT CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3614 WINDER HWY UNIT 2210
FLOWERY BRANCH GA
30542-3019
US

IV. Provider business mailing address

335 PEACHTREE INDUSTRIAL BLVD SUITE 2210
SUWANEE GA
30024-3756
US

V. Phone/Fax

Practice location:
  • Phone: 770-932-8869
  • Fax: 770-932-8870
Mailing address:
  • Phone: 770-932-8869
  • Fax: 770-932-8870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN012963
License Number StateGA

VIII. Authorized Official

Name: STACEY C NEWTON-BOOKER
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 770-932-8869