Organization
SELF MEDICAL GROUP
Active
Other names
Family Healthcare Ninety Six, A Division of Self Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW T LOGAN (PRESIDENT AND CEO)
(864) 725-4253
Entity
Organization
Contact information
Practice address
103 LITTLE MOUNTAIN RD, NINETY SIX, SC 29666-9252
(864) 543-3515
Mailing address
103 LITTLE MOUNTAIN RD, NINETY SIX, SC 29666-9252
(864) 543-3515
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
04/14/2015
Last updated
12/14/2021
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