Organization
SELF MEDICAL GROUP
Active
Other names
Lifestyle Clinic of Self Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW T LOGAN MD (PRESIDENT AND CEO)
(864) 725-4253
Entity
Organization
Contact information
Practice address
410 EPTING AVE, GREENWOOD, SC 29646-4040
(864) 725-7880
(864) 725-7875
Mailing address
410 EPTING AVE, GREENWOOD, SC 29646-4040
(864) 725-7880
(864) 725-7875
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
04/16/2019
Last updated
12/14/2021
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