NPIMap

Organization Active NPI

Southern Behavioral Medicine Associates PLLC

  • Health Psychologist
  • Hattiesburg, MS
National Provider Identifier
1487950564
Registry record updated Aug 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health PsychologistTaxonomy code 103TH0004X
Legal business name
SOUTHERN BEHAVIORAL MEDICINE ASSOCIATES PLLC
Practice address
1 Commerce Dr
Ste 106
Hattiesburg, MS 39402-1499
Phone
(601) 255-1618
Fax
(601) 255-1619
NPI assigned
Feb 7, 2011
Last updated
Aug 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Geralyn Datz, PHDNPI 1972616076
Title
Ceo/Director
Phone
(601) 255-1618

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Health PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TH0004X Primary

Addresses

Primary practice location

1 Commerce Dr
Ste 106
Hattiesburg, MS 39402-1499

Mailing address

PO Box 18799
Hattiesburg, MS 39404-8799
Phone (601) 255-1618

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110309000840 LA Part B Supplier - Clinic/Group Practice 0547442766 Receives reassigned benefits from 1 practitioner
Practice locations: New Orleans, LA; Slidell, LA
O20110329000359 MS Part B Supplier - Clinic/Group Practice 0547442766 Receives reassigned benefits from 7 practitioners
Practice locations: Hattiesburg, MS

National Provider Directory

National Provider Directory

Locations

201 Saint Charles Ave
Ste 2500
New Orleans, LA 70170
Phone (504) 224-6402

995 Robert Blvd
Ofc
Slidell, LA 70458
Phone (601) 255-1618

1 Commerce Dr
Ste 106
Hattiesburg, MS 39402
Phone (601) 255-1618

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786665600000",
    "number": "1487950564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18799",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394048799",
            "telephone_number": "601-255-1618",
            "fax_number": "601-255-1619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 COMMERCE DR",
            "address_2": "STE 106",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021499",
            "telephone_number": "601-255-1618",
            "fax_number": "601-255-1619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN BEHAVIORAL MEDICINE ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-07",
        "last_updated": "2026-08-14",
        "certification_date": "2026-08-14",
        "status": "A",
        "authorized_official_last_name": "DATZ",
        "authorized_official_first_name": "GERALYN",
        "authorized_official_title_or_position": "CEO/DIRECTOR",
        "authorized_official_telephone_number": "601-255-1618",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.