Provider Demographics
NPI:1588651277
Name:MCCONNELL, HUGH TIMOTHY (PA-C)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:TIMOTHY
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 PRINCETON AVE SW
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1323
Mailing Address - Country:US
Mailing Address - Phone:205-684-7079
Mailing Address - Fax:
Practice Address - Street 1:833 PRINCETON AVE SW STE 200A
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1321
Practice Address - Country:US
Practice Address - Phone:205-684-7079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103629363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA156353062BMedicaid
P00328040OtherMEDICARE RAILROAD
FL292402100Medicaid
FL292402100Medicaid
P00328040OtherMEDICARE RAILROAD
FLU6947XMedicare PIN
FLU6947YMedicare PIN