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Individual

DR. GERALYN DATZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
1 COMMERCE DR, STE 205, HATTIESBURG, MS 39402-1499
(601) 255-1618
(601) 255-1619
Mailing address
PO BOX 1614, HATTIESBURG, MS 39403-1614
(601) 255-1618
(601) 255-1619

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
1140
LA
103TC0700X
Clinical Psychologist
45736
MS
103TH0004X
Health Psychologist
1140
LA
103TH0004X
Health Psychologist
Primary
45-736
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009933077
AL
05
06036275
MS
Enumeration date
08/16/2006
Last updated
11/30/2011
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