Provider Demographics
NPI:1740515006
Name:LYERLY BAPTIST INC
Entity type:Organization
Organization Name:LYERLY BAPTIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-376-4275
Mailing Address - Street 1:836 PRUDENTIAL DR
Mailing Address - Street 2:SUITE 1601
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8334
Mailing Address - Country:US
Mailing Address - Phone:904-396-2400
Mailing Address - Fax:904-396-3750
Practice Address - Street 1:836 PRUDENTIAL DR
Practice Address - Street 2:SUITE 1601
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8334
Practice Address - Country:US
Practice Address - Phone:904-396-2400
Practice Address - Fax:904-396-3750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty