Organization
SELF MEDICAL GROUP
Active
Other names
Light and Life Wellness Clinic
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
450 OLD BRICKYARD RD, GREENWOOD, SC 29649-8681
(864) 725-7491
Mailing address
104 WELLS AVE, GREENWOOD, SC 29646-3837
(864) 725-7491
Taxonomy
Speciality
Code
Description
License number
State
261QX0100X
Occupational Medicine Clinic/Center
Primary
—
—
Other
Enumeration date
03/11/2014
Last updated
12/14/2021
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