Organization
SELF MEDICAL GROUP
Active
Other names
Internal Medical Laurens a division of Self Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW T LOGAN MD (PRESIDENT AND CHIEF EXECUTIVE OFFIC)
(864) 725-4253
Entity
Organization
Contact information
Practice address
22580 HIGHWAY 76 E, SUITE 200, LAURENS, SC 29360-8439
(864) 833-0055
(864) 833-4008
Mailing address
22580 HIGHWAY 76 E, SUITE 200, LAURENS, SC 29360-8439
(864) 833-0055
(864) 833-4008
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP5453
—
SC
Enumeration date
06/28/2010
Last updated
12/14/2021
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