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General NPI Number Information
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NPI Number | 1396755054
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Entity Type | Individual
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Provider Name | JOSEPH WILLIS LOGAN SR. MD
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 1325 SPRING ST
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City | GREENWOOD
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State | SC
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Zip | 29646-3860
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Country | US
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Telephone | 864-725-4780
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Fax | 864-725-4778
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Provider Business Mailing Address
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Address Line | 1325 SPRING ST
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City | GREENWOOD
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State | SC
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Zip | 29646-3860
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Country | US
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Telephone | 864-725-4780
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Fax | 864-725-4778
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 8327
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 8327
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License Number State | SC
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