Provider Demographics
NPI:1821313883
Name:LYERLY BAPTIST INC
Entity Type:Organization
Organization Name:LYERLY BAPTIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:B
Authorized Official - Last Name:MALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-376-4275
Mailing Address - Street 1:14546 OLD SAINT AUGUSTINE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5468
Mailing Address - Country:US
Mailing Address - Phone:904-292-4049
Mailing Address - Fax:904-292-4805
Practice Address - Street 1:14546 OLD SAINT AUGUSTINE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5468
Practice Address - Country:US
Practice Address - Phone:904-292-4049
Practice Address - Fax:904-292-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME811472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty