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General NPI Number Information
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NPI Number | 1164242830
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Entity Type | Organization
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Legal Business Name | LYERLY BAPTIST INC
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 400 COLONNADE DR STE 230
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City | PONTE VEDRA
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State | FL
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Zip | 32081-6237
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Country | US
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Telephone | 904-202-1795
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Fax | 904-376-3478
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Provider Business Mailing Address
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Address Line | PO BOX 746647
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City | ATLANTA
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State | GA
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Zip | 30374-6647
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Country | US
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Telephone | 904-202-2092
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Fax | 904-376-4075
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CATHERINE HOLLOWAY
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Credential |
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Telephone | 904-202-5378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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