# SELF MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Light and Life Wellness Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760808083
- **Authorized official:** DR. MATTHEW T LOGAN MD (PRESIDENT AND CEO)
- **Authorized official phone:** (864) 725-4253

## Contact information

- **Practice address:** 450 OLD BRICKYARD RD, GREENWOOD, SC 29649-8681
- **Practice address phone:** (864) 725-7491
- **Mailing address:** 104 WELLS AVE, GREENWOOD, SC 29646-3837
- **Mailing address phone:** (864) 725-7491

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QX0100X | Occupational Medicine Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/11/2014
- **Last updated:** 12/14/2021