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NPI Code Detail

MEDICARE: LYERLY BAPTIST INC

MEDICARE: LYERLY BAPTIST INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RS0010XSports Medicine (Internal Medicine) Physician
2207QS0010XSports Medicine (Family Medicine) Physician
3207XX0005XSports Medicine (Orthopaedic Surgery) Physician
4207X00000XOrthopaedic Surgery Physician

General Provider Information

NPI Number : 1063387116
Entity Type Code : Organization
Provider Name (Legal Business Name) : LYERLY BAPTIST INC
Provider Business Mailing Address
First Line : PO BOX 746647
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6647
Country : US
Telephone Number : 904-202-2092
Fax Number : 904-376-4075
Provider Business Practice Location Address
First Line : 1348 S 18TH ST STE 200
Second Line :
City : FERNANDINA BEACH
State : FL
Zip : 32034-4785
Country : US
Telephone Number : 904-202-6683
Fax Number : 904-376-3062
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : TYRONE MCCLOUD
Credential :
Telephone Number : 904-202-6683
Provider Enumeration Date : 10/08/2025
Last Update Date : 03/03/2026

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Directions to “LYERLY BAPTIST INC ” Practice Location

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