Provider Demographics
NPI:1285686618
Name:ANYANWU, ALLYSON (MD)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:ANYANWU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-4825
Mailing Address - Country:US
Mailing Address - Phone:731-574-9111
Mailing Address - Fax:731-574-9999
Practice Address - Street 1:504 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-4825
Practice Address - Country:US
Practice Address - Phone:731-574-9111
Practice Address - Fax:731-574-9999
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7778207P00000X
TN40626207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ069985Medicaid