| Lyerly Baptist Inc | |
|
400 Colonnade Dr Ste 230 Ponte Vedra FL 32081-6237 | |
| (904) 202-1795 | |
| (904) 376-3478 |
| Full Name | Lyerly Baptist Inc |
|---|---|
| Speciality | Family Medicine - Obesity Medicine |
| Location | 400 Colonnade Dr Ste 230, Ponte Vedra, Florida |
| Authorized Official Name and Position | Catherine Holloway (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9042025378 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lyerly Baptist Inc Po Box 746647 Atlanta GA 30374-6647 Ph: (904) 202-2092 | Lyerly Baptist Inc 400 Colonnade Dr Ste 230 Ponte Vedra FL 32081-6237 Ph: (904) 202-1795 |
| NPI Number | 1164242830 |
|---|---|
| Provider Enumeration Date | 10/16/2024 |
| Last Update Date | 10/16/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164242830 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QB0002X | Family Medicine - Obesity Medicine | (* (Not Available)) | Primary |
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