Healthcare Provider Details

I. General information

NPI: 1023733557
Provider Name (Legal Business Name): ELITE PSYCHIATRY OF TENNESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 HENSLEE DR
DICKSON TN
37055-2166
US

IV. Provider business mailing address

403 HENSLEE DR
DICKSON TN
37055-2166
US

V. Phone/Fax

Practice location:
  • Phone: 615-637-3131
  • Fax: 931-208-3616
Mailing address:
  • Phone: 615-637-3131
  • Fax: 931-208-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: KD WAINWRIGHT
Title or Position: OWNER
Credential: PA
Phone: 615-637-3131