Healthcare Provider Details

I. General information

NPI: 1770552481
Provider Name (Legal Business Name): BRIGHT MCCONNELL III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

900 ISLAND PARK DR SUITE 105
DANIEL ISLAND 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 Number12452
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: