Organization
SELF MEDICAL GROUP
Active
Other names
Lakelands Ear Nose and Throat
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW TOLBERT LOGAN MD (CEO)
(864) 725-4780
Entity
Organization
Contact information
Practice address
1015 SPRING ST, GREENWOOD, SC 29646-3831
(864) 227-6741
Mailing address
1015 SPRING ST, GREENWOOD, SC 29646-3831
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
231H00000X
Audiologist
—
—
Other
Enumeration date
01/26/2024
Last updated
06/12/2024
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