# SELF MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pediatric Associates Greenwood, A Division of Self Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720475221
- **Authorized official:** DR. MATTHEW T LOGAN MD (PRESIDENT AND CEO)
- **Authorized official phone:** (864) 725-4253

## Contact information

- **Practice address:** 210 WELLS AVE, GREENWOOD, SC 29646-3843
- **Practice address phone:** (864) 943-4279
- **Practice address fax:** (864) 223-2642
- **Mailing address:** 210 WELLS AVE, GREENWOOD, SC 29646-3843
- **Mailing address phone:** (864) 943-4279
- **Mailing address fax:** (864) 223-2642

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | Yes |
| 208000000X | Pediatrics Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0200X | Pediatric Nurse Practitioner | — | NULL | — |
| 363LP0200X | Pediatric Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/22/2015
- **Last updated:** 12/14/2021