Provider Demographics
NPI:1033182241
Name:MASSIE, NICOLISA D (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLISA
Middle Name:D
Last Name:MASSIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3485 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5603
Mailing Address - Country:US
Mailing Address - Phone:205-930-0920
Mailing Address - Fax:205-445-0115
Practice Address - Street 1:3485 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-5603
Practice Address - Country:US
Practice Address - Phone:205-930-0920
Practice Address - Fax:205-445-0115
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00019447208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009940783Medicaid
AL1911001OtherUNITED HEALTHCARE
ALH17904OtherVIVA
AL3069868001OtherCIGNA
AL51096368OtherMEDICARE
AL0366100001OtherMC NSC
ALH17904OtherHEALTH SPRINGS
AL7693171OtherAETNA
ALD815OtherMEDICARE GROUP PIN
AL0366100001OtherCIGNA GOVERNMENT SERVICES PTAN
AL0366100001OtherCIGNA GOVERNMENT SERVICES PTAN