Organization
SELF MEDICAL GROUP
Active
Other names
Pediatric Associates Greenwood, A Division of Self Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW T LOGAN MD (PRESIDENT AND CEO)
(864) 725-4253
Entity
Organization
Contact information
Practice address
210 WELLS AVE, GREENWOOD, SC 29646-3843
(864) 943-4279
(864) 223-2642
Mailing address
210 WELLS AVE, GREENWOOD, SC 29646-3843
(864) 943-4279
(864) 223-2642
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
208000000X
Pediatrics Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Enumeration date
04/22/2015
Last updated
12/14/2021
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