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General NPI Number Information
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NPI Number | 1699972935
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Entity Type | Organization
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Legal Business Name | BRIGHT MCCONNELL III MD LLC
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | 900 ISLAND PARK DR SUITE 105
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City | CHARLESTON
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State | SC
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Zip | 29492-7559
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Country | US
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Telephone | 843-284-5200
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Fax | 843-284-5201
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Provider Business Mailing Address
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Address Line | 900 ISLAND PARK DR SUITE 105
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City | CHARLESTON
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State | SC
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Zip | 29492-7559
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Country | US
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Telephone | 843-284-5200
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Fax | 843-284-5201
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIGHT MCCONNELL III
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Credential | MD
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Telephone | 843-284-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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