Active NPI
Christopher Malik Fayne, LAT, ATC
- Athletic Trainer
- Rome, GA
National Provider Identifier
1033829007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT004320
- Practice address
- 600 Redmond Rd NW Apt G11
Rome, GA 30165-1428 - Phone
- (901) 277-0633
- NPI assigned
- Dec 1, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT004320 | GA | Primary |
Addresses
Primary practice location
600 Redmond Rd NW Apt G11
Rome, GA 30165-1428
Mailing address
600 Redmond Rd NW Apt G11
Rome, GA 30165-1428
Phone (901) 277-0633
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT004320 | GA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669852800000",
"number": "1033829007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 REDMOND RD NW APT G11",
"city": "ROME",
"state": "GA",
"postal_code": "301651428",
"telephone_number": "901-277-0633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 REDMOND RD NW APT G11",
"city": "ROME",
"state": "GA",
"postal_code": "301651428",
"telephone_number": "901-277-0633"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAYNE",
"first_name": "CHRISTOPHER",
"middle_name": "MALIK",
"name_prefix": "Mr.",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-12-01",
"last_updated": "2022-12-01",
"certification_date": "2022-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "GA",
"license": "AT004320",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rome, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.