Healthcare Provider Details

I. General information

NPI: 1699972935
Provider Name (Legal Business Name): BRIGHT MCCONNELL III MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ISLAND PARK DR SUITE 105
CHARLESTON SC
29492-7559
US

IV. Provider business mailing address

900 ISLAND PARK DR SUITE 105
CHARLESTON SC
29492-7559
US

V. Phone/Fax

Practice location:
  • Phone: 843-284-5200
  • Fax: 843-284-5201
Mailing address:
  • Phone: 843-284-5200
  • Fax: 843-284-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIGHT MCCONNELL III
Title or Position: OWNER
Credential: MD
Phone: 843-284-5200