# SELF MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Advanced Gastroenterology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841047560
- **Authorized official:** MATTHEW TOLBERT LOGAN MD (CEO)
- **Authorized official phone:** (864) 725-4780

## Contact information

- **Practice address:** 160 ACADEMY AVE, GREENWOOD, SC 29646-3808
- **Practice address phone:** (864) 223-8090
- **Mailing address:** 75 REMITTANCE DR DEPT 6764, CHICAGO, IL 60675-6764
- **Mailing address phone:** (864) 725-7491

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | — | NULL | Yes |
| 207RG0100X | Gastroenterology Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/01/2024
- **Last updated:** 05/22/2024