Organization
LYERLY BAPTIST INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EARL B MALLY (SENIOR VICE PRESIDENT)
(904) 376-4275
Entity
Organization
Contact information
Practice address
14546 OLD SAINT AUGUSTINE RD, SUITE 301, JACKSONVILLE, FL 32258-5468
(904) 292-4049
(904) 292-4805
Mailing address
14546 OLD SAINT AUGUSTINE RD, SUITE 301, JACKSONVILLE, FL 32258-5468
(904) 292-4049
(904) 292-4805
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME81147
FL
Other
Enumeration date
04/02/2010
Last updated
04/02/2010
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