# SELF MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** South Carolina Spine Associates, A Division of SMG
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134442890
- **Authorized official:** DR. MATTHEW T LOGAN MD (PRESIDENT AND CEO)
- **Authorized official phone:** (864) 725-4253

## Contact information

- **Practice address:** 115 ACADEMY AVENUE, UNIT A, GREENWOOD, SC 29646
- **Practice address phone:** (864) 725-7272
- **Practice address fax:** (864) 725-5764
- **Mailing address:** 115 ACADEMY AVENUE, UNIT A, GREENWOOD, SC 29646
- **Mailing address phone:** (864) 725-7272
- **Mailing address fax:** (864) 725-5764

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 03/10/2010
- **Last updated:** 12/14/2021