Provider Demographics
NPI:1396129243
Name:MASSENGILL, ABBIE CRISTINE (MD)
Entity type:Individual
Prefix:
First Name:ABBIE
Middle Name:CRISTINE
Last Name:MASSENGILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 784
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-0784
Mailing Address - Country:US
Mailing Address - Phone:217-342-3337
Mailing Address - Fax:217-347-3328
Practice Address - Street 1:912 N HENRIETTA ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1788
Practice Address - Country:US
Practice Address - Phone:217-342-3337
Practice Address - Fax:217-347-3328
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36150213207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology