Healthcare Provider Details

I. General information

NPI: 1871413468
Provider Name (Legal Business Name): BOOKER FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 N HIGHWAY 11
WEST UNION SC
29696-2715
US

IV. Provider business mailing address

1205 N HIGHWAY 11
WEST UNION SC
29696-2715
US

V. Phone/Fax

Practice location:
  • Phone: 864-638-5402
  • Fax: 864-638-6126
Mailing address:
  • Phone: 864-638-5402
  • Fax: 864-638-6126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD HENRY BOOKER JR.
Title or Position: CEO
Credential: MD
Phone: 864-638-5402