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Organization
SELF MEDICAL GROUP
Active
Organization
SELF MEDICAL GROUP
Active
Other names
Lakelands Plastic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW T LOGAN MD (PRESIDENT AND CEO)
(864) 725-4253
Entity
Organization
Contact information
Practice address
305 W ALEXANDER AVE # A, GREENWOOD, SC 29646-4009
(864) 223-0505
(864) 223-7075
Mailing address
305 W ALEXANDER AVE # A, GREENWOOD, SC 29646-4009
(864) 223-0505
(864) 223-7075
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Enumeration date
09/21/2022
Last updated
11/07/2022
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