Organization
SELF REGIONAL HEALTHCARE
Active
Other names
Lakelands Ear Nose and Throat
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW TOLBERT LOGAN (PRESIDENT & CEO)
(864) 725-4780
Entity
Organization
Contact information
Practice address
1015 SPRING ST, GREENWOOD, SC 29646-3831
(864) 227-6741
(864) 227-2046
Mailing address
104 WELLS AVE, GREENWOOD, SC 29646-3837
(864) 725-4673
(864) 725-7424
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Enumeration date
03/10/2025
Last updated
03/10/2025
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