Provider Demographics
NPI:1144899055
Name:WILDER, ELIJAH FORREST (MD)
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:FORREST
Last Name:WILDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:222 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1852
Mailing Address - Country:US
Mailing Address - Phone:629-255-3486
Mailing Address - Fax:629-255-3075
Practice Address - Street 1:325 OLD PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4493
Practice Address - Country:US
Practice Address - Phone:629-255-2240
Practice Address - Fax:629-255-4292
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2025-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN742212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ102837Medicaid