Provider Demographics
NPI:1184653453
Name:FAIN, GUY FRANKLIN III (MD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:FRANKLIN
Last Name:FAIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PRENTICE LN
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-2037
Mailing Address - Country:US
Mailing Address - Phone:423-605-0629
Mailing Address - Fax:
Practice Address - Street 1:10 PRENTICE LN
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-2037
Practice Address - Country:US
Practice Address - Phone:423-605-0629
Practice Address - Fax:423-517-0017
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD14797207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00201541OtherRAILROAD MEDICARE
TN3001403Medicaid
GA000614083BMedicaid
TN4150076OtherBLUE CROSS
TN3133610OtherBCBS OF TENNESSEE
TN3001404Medicaid
TN3133610OtherBCBS OF TENNESSEE
TNP00201541OtherRAILROAD MEDICARE