| Magnolia Premier Medical Group Pllc | |
|
1000 Highland Colony Pkwy Ste 35203 Ridgeland MS 39157-2073 | |
| (601) 613-5682 | |
| (601) 372-3059 |
| Full Name | Magnolia Premier Medical Group Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1000 Highland Colony Pkwy Ste 35203, Ridgeland, Mississippi |
| Authorized Official Name and Position | Craig Damon Henry (FAMILY MEDICINE PROVIDER) |
| Authorized Official Contact | 6016135681 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Premier Medical Group Pllc 4366 S Siwell Rd Byram MS 39212-6213 Ph: (601) 613-5681 | Magnolia Premier Medical Group Pllc 1000 Highland Colony Pkwy Ste 35203 Ridgeland MS 39157-2073 Ph: (601) 613-5682 |
| NPI Number | 1164293387 |
|---|---|
| Provider Enumeration Date | 01/16/2024 |
| Last Update Date | 01/16/2024 |
| Medicare PECOS PAC ID | 0941644405 |
|---|---|
| Medicare Enrollment ID | O20240223000260 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164293387 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Craig Damon Henry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639717713 PECOS PAC ID: 1850713769 Enrollment ID: I20200623001929 |
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