# SELF REGIONAL HEALTHCARE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pain Management Laurens
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720938103
- **Authorized official:** MATTHEW TOLBERT LOGAN (PRESIDENT & CEO)
- **Authorized official phone:** (864) 725-4780

## Contact information

- **Practice address:** 23013 HIGHWAY 76 E STE C, CLINTON, SC 29325-7530
- **Practice address phone:** (864) 725-4095
- **Mailing address:** 1325 SPRING ST, GREENWOOD, SC 29646-3875
- **Mailing address phone:** (864) 725-4673
- **Mailing address fax:** (864) 725-7424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 2084P2900X | Pain Medicine (Psychiatry & Neurology) Physician | — | NULL | — |
| 2084P2900X | Pain Medicine (Psychiatry & Neurology) Physician | — | — | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 02/03/2026
- **Last updated:** 09/18/2026