Provider Demographics
NPI:1972651115
Name:BRIGHT, PAUL WILLIAM JR
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:WILLIAM
Last Name:BRIGHT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 WALTHOUR RD # B
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-3204
Mailing Address - Country:US
Mailing Address - Phone:912-897-7363
Mailing Address - Fax:
Practice Address - Street 1:1310 WALTHOUR RD # B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-3204
Practice Address - Country:US
Practice Address - Phone:912-897-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC009557183500000X
GA017197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist