Organization
SELF MEDICAL GROUP
Active
Other names
Advanced Gastroenterology
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW TOLBERT LOGAN MD (CEO)
(864) 725-4780
Entity
Organization
Contact information
Practice address
160 ACADEMY AVE, GREENWOOD, SC 29646-3808
(864) 223-8090
Mailing address
75 REMITTANCE DR DEPT 6764, CHICAGO, IL 60675-6764
(864) 725-7491
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Enumeration date
05/01/2024
Last updated
05/22/2024
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