| Lifestyle Clinic Of Self Medical Group | |
|
410 Epting Ave Greenwood SC 29646-4040 | |
| (864) 725-7880 | |
| (864) 725-7875 |
| Full Name | Lifestyle Clinic Of Self Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 410 Epting Ave, Greenwood, South Carolina |
| Authorized Official Name and Position | Matthew T Logan (PRESIDENT AND CEO) |
| Authorized Official Contact | 8647254253 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifestyle Clinic Of Self Medical Group 410 Epting Ave Greenwood SC 29646-4040 Ph: (864) 725-7880 | Lifestyle Clinic Of Self Medical Group 410 Epting Ave Greenwood SC 29646-4040 Ph: (864) 725-7880 |
| NPI Number | 1013570910 |
|---|---|
| Provider Enumeration Date | 04/16/2019 |
| Last Update Date | 12/14/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013570910 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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