Basic Information
| Provider Information | |||||||||
| NPI: | 1174553200 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILKERSON | ||||||||
| FirstName: | EMMETT | ||||||||
| MiddleName: | EARL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 BRENTSHIRE SQ | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383052203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316640994 | ||||||||
| FaxNumber: | 7316640866 | ||||||||
| Practice Location | |||||||||
| Address1: | 1999 HIGHWAY 51 S | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380193630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014764457 | ||||||||
| FaxNumber: | 9014754389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 41155 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 188282 | 01 | TN | UNISON | OTHER | 37939 | 01 | TN | TLC | OTHER | 3811270 | 05 | TN | MEDICAID | 10025647 | 01 | TN | UAHC | OTHER | 4130301 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 9396704 | 01 | TN | CIGNA | OTHER |