Provider Demographics
NPI:1952116188
Name:IKARD, ELIJAH DAVID
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:DAVID
Last Name:IKARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8153 MIDDLEWICK LN
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-4010
Mailing Address - Country:US
Mailing Address - Phone:786-858-2115
Mailing Address - Fax:
Practice Address - Street 1:739 PRESIDENT PL STE 110
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6845
Practice Address - Country:US
Practice Address - Phone:615-625-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician