Organization
SELF MEDICAL GROUP
Active
Other names
Virtual Services
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW T LOGAN MD (PRESIDENT AND CEO)
(864) 725-4253
Entity
Organization
Contact information
Practice address
410 EPTING AVE, GREENWOOD, SC 29646-4040
(864) 725-5326
(864) 725-5327
Mailing address
410 EPTING AVE, GREENWOOD, SC 29646-4040
(864) 725-5326
(864) 725-5327
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/24/2022
Last updated
10/18/2022
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