Provider Demographics
NPI:1184771321
Name:GOLDEN CORNER FAMILY PRAC
Entity type:Organization
Organization Name:GOLDEN CORNER FAMILY PRAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOOKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:864-638-5402
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29696-0219
Mailing Address - Country:US
Mailing Address - Phone:864-638-5402
Mailing Address - Fax:864-638-6126
Practice Address - Street 1:1205 N HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:SC
Practice Address - Zip Code:29696-2715
Practice Address - Country:US
Practice Address - Phone:864-638-5402
Practice Address - Fax:864-638-6126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC094953Medicaid
SCL31366Medicaid
SCL31357Medicaid
SCH00653Medicare UPIN
SCH38053Medicare UPIN
SC094953Medicaid