Individual
DR. WALTER WORLEY FAIN III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
659 MORGANTON SQUARE DR, MARYVILLE, TN 37801-4763
(865) 983-3348
(615) 296-4440
Mailing address
659 MORGANTON SQUARE DR, MARYVILLE, TN 37801-4763
(865) 983-3348
(615) 296-4440
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P0000001139
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2004080
BLUE CROSS NUMBER
TN
01
—
62-1424098-379200000
CHAMPUS NUMBER
TN
Enumeration date
12/15/2005
Last updated
02/02/2009
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