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
1747 BAPTIST CLAY DR STE 200, FLEMING ISLAND, FL 32003-8505
(904) 516-1950
(904) 376-3062
Mailing address
PO BOX 746647, ATLANTA, GA 30374-6647
(904) 202-2092
(904) 376-4075
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
213E00000X
Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
08/26/2024
Last updated
10/24/2025
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