Provider Demographics
NPI:1174553200
Name:WILKERSON, EMMETT EARL (MD)
Entity type:Individual
Prefix:
First Name:EMMETT
Middle Name:EARL
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BRENTSHIRE SQ
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2203
Mailing Address - Country:US
Mailing Address - Phone:731-664-0994
Mailing Address - Fax:731-664-0866
Practice Address - Street 1:2464 OLD FORT PKWY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-4163
Practice Address - Country:US
Practice Address - Phone:615-410-3137
Practice Address - Fax:615-410-3427
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41155207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN188282OtherUNISON
TN626001636OtherUNITED HEALTHCARE
TN9396704OtherCIGNA
TN626001636OtherUSA MANAGED CARE
TN10025647OtherUAHC
TN37939OtherTLC
TN3811270Medicaid
TN626001636OtherBAPTIST HEALTH SERVICE GR
TN4130301OtherBLUE CROSS BLUE SHIELD