| Southern Behavioral Medicine Associates Pllc | |
|
1 Commerce Dr Ste 106 Hattiesburg MS 39402-1499 | |
| (601) 255-1618 | |
| (601) 255-1619 |
| Full Name | Southern Behavioral Medicine Associates Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 1 Commerce Dr, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Geralyn Datz (CLINICAL DIRECTOR/OWNER) |
| Authorized Official Contact | 6012551618 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Behavioral Medicine Associates Pllc Po Box 18799 Hattiesburg MS 39404-8799 Ph: (601) 255-1618 | Southern Behavioral Medicine Associates Pllc 1 Commerce Dr Ste 106 Hattiesburg MS 39402-1499 Ph: (601) 255-1618 |
| NPI Number | 1487950564 |
|---|---|
| Provider Enumeration Date | 02/07/2011 |
| Last Update Date | 01/15/2013 |
| Medicare PECOS PAC ID | 0547442766 |
|---|---|
| Medicare Enrollment ID | O20110309000840 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487950564 | NPI | - | NPPES |
| Provider Name | Geralyn Datz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972616076 PECOS PAC ID: 3870510431 Enrollment ID: I20110309000889 |
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