Healthcare Provider Details

I. General information

NPI: 1083319628
Provider Name (Legal Business Name): LAILA ANNAMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASIA ANNAMER MD

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 PHYSICIANS DR
JACKSON TN
38305-2070
US

IV. Provider business mailing address

24 PHYSICIANS DR
JACKSON TN
38305-2070
US

V. Phone/Fax

Practice location:
  • Phone: 731-609-8738
  • Fax:
Mailing address:
  • Phone: 731-609-8738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number76854
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: