Walter Worley Fain III, ED.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

P0000001139 Issued in TN

Practice address

659 Morganton Square Dr
Maryville, TN 37801-4763

Phone

(865) 983-3348

Fax

(615) 296-4440

NPI assigned

Dec 15, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233532800000",
    "number": "1972589638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "659 MORGANTON SQUARE DR",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378014763",
            "telephone_number": "865-983-3348",
            "fax_number": "615-296-4440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "659 MORGANTON SQUARE DR",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378014763",
            "telephone_number": "865-983-3348",
            "fax_number": "615-296-4440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIN",
        "first_name": "WALTER",
        "middle_name": "WORLEY",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "ED.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2009-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "P0000001139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS NUMBER",
            "identifier": "2004080",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS NUMBER",
            "identifier": "62-1424098-379200000",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samuel Dixie Evans, M.D.
• Morgan Everett
• Shannon Everett, NP-C
• Tammie Sue Ewing, PHARMD
• Anna Fain, RN
• Tasheema Lanell Fair, M.D
• Allison B. Falin, FNP
• David Lewis Farmer, RPH
• Gladys Farmer, BS
• Fast Pace Medical Clinic PLLC

• Clinical Psychologist in Maryville, TN
• Providers in Maryville, TN by specialty
• Clinical Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.