# MAGNOLIA PREMIER MEDICAL GROUP PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164293387
- **Authorized official:** CRAIG DAMON HENRY APRN, FNP-C (FAMILY MEDICINE PROVIDER)
- **Authorized official phone:** (601) 613-5681

## Contact information

- **Practice address:** 1000 HIGHLAND COLONY PKWY STE 35203, RIDGELAND, MS 39157-2073
- **Practice address phone:** (601) 613-5682
- **Practice address fax:** (601) 372-3059
- **Mailing address:** 4366 S SIWELL RD, BYRAM, MS 39212-6213
- **Mailing address phone:** (601) 613-5681
- **Mailing address fax:** (601) 372-3059

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/16/2024
- **Last updated:** 01/16/2024