Provider Demographics
NPI:1770552481
Name:MCCONNELL, BRIGHT III (MD)
Entity type:Individual
Prefix:
First Name:BRIGHT
Middle Name:
Last Name:MCCONNELL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 ISLAND PARK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7559
Mailing Address - Country:US
Mailing Address - Phone:843-284-5200
Mailing Address - Fax:843-284-5201
Practice Address - Street 1:900 ISLAND PARK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7559
Practice Address - Country:US
Practice Address - Phone:843-284-5200
Practice Address - Fax:843-284-5201
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12452207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8454Medicare PIN
SCD05669Medicare UPIN