# SELF MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lakelands Ear Nose and Throat
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134981947
- **Authorized official:** MATTHEW TOLBERT LOGAN MD (CEO)
- **Authorized official phone:** (864) 725-4780

## Contact information

- **Practice address:** 1015 SPRING ST, GREENWOOD, SC 29646-3831
- **Practice address phone:** (864) 227-6741
- **Mailing address:** 1015 SPRING ST, GREENWOOD, SC 29646-3831

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | — | NULL | Yes |
| 207Y00000X | Otolaryngology Physician | — | — | Yes |
| 231H00000X | Audiologist | — | NULL | — |
| 231H00000X | Audiologist | — | — | — |

## Other

- **Enumeration date:** 01/26/2024
- **Last updated:** 06/12/2024