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General NPI Number Information
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NPI Number | 1700775483
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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 | 06/30/2025
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Last Update Date | 12/26/2025
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Provider Practice Location Address
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Address Line | 851042 US HIGHWAY 17 STE A
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City | YULEE
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State | FL
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Zip | 32097-2845
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Country | US
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Telephone | 904-202-6683
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Fax | 904-376-3062
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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 | TYRONE MCCLOUD
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Credential | EXECUTIVE DIRECTOR
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Telephone | 904-202-5367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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