Healthcare Provider Details

I. General information

NPI: 1174553200
Provider Name (Legal Business Name): EMMETT EARL WILKERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2464 OLD FORT PKWY
MURFREESBORO TN
37128-4163
US

IV. Provider business mailing address

16 BRENTSHIRE SQ
JACKSON TN
38305-2203
US

V. Phone/Fax

Practice location:
  • Phone: 615-410-3137
  • Fax: 615-410-3427
Mailing address:
  • Phone: 731-664-0994
  • Fax: 731-664-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number41155
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41155
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: