Organization
LYERLY BAPTIST INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYRONE MCCLOUD (EXECUTIVE DIRECTOR)
(904) 202-5367
Entity
Organization
Contact information
Practice address
1650 PRUDENTIAL DR STE 200, JACKSONVILLE, FL 32207-8149
(904) 388-6518
(904) 384-1005
Mailing address
PO BOX 746647, ATLANTA, GA 30374-6647
(904) 202-2092
(904) 376-4075
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QB0002X
Obesity Medicine (Family Medicine) Physician
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207RS0010X
Sports Medicine (Internal Medicine) Physician
—
—
207T00000X
Neurological Surgery Physician
Primary
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
2084A2900X
Neurocritical Care Physician
—
—
213E00000X
Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274381700
—
FL
Enumeration date
05/25/2006
Last updated
04/23/2026
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