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General NPI Number Information
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NPI Number | 1174553200
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Entity Type | Individual
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Provider Name | EMMETT EARL WILKERSON MD
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Gender | Male
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 2464 OLD FORT PKWY
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City | MURFREESBORO
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State | TN
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Zip | 37128-4163
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Country | US
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Telephone | 615-410-3137
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Fax | 615-410-3427
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Provider Business Mailing Address
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Address Line | 16 BRENTSHIRE SQ
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City | JACKSON
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State | TN
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Zip | 38305-2203
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Country | US
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Telephone | 731-664-0994
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Fax | 731-664-0866
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 41155
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 41155
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License Number State | TN
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