Healthcare Provider Details

I. General information

NPI: 1720938103
Provider Name (Legal Business Name): SELF REGIONAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23013 HIGHWAY 76 E STE C
CLINTON SC
29325-7530
US

IV. Provider business mailing address

1325 SPRING ST
GREENWOOD SC
29646-3875
US

V. Phone/Fax

Practice location:
  • Phone: 864-725-4095
  • Fax:
Mailing address:
  • Phone: 864-725-4673
  • Fax: 864-725-7424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW TOLBERT LOGAN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 864-725-4780