Yoshitaro Oba

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY004118 Issued in GA

Practice address

10475 Medlock Bridge Rd Ste 315
Johns Creek, GA 30097-4446

Phone

(678) 935-9567

Fax

(678) 935-9568

NPI assigned

Sep 2, 2017

Last updated

Apr 2, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2022 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Yoshitaro Oba, PH.D., P.C.

  • Community/Behavioral Health Agency
  • Johns Creek, GA
  • NPI 1316553274
  Authorized official Same address or phone

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

{
    "created_epoch": "1504310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775088000000",
    "number": "1265950851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10475 MEDLOCK BRIDGE RD STE 315",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300974446",
            "telephone_number": "678-935-9567",
            "fax_number": "678-935-9568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10475 MEDLOCK BRIDGE RD STE 315",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300974446",
            "telephone_number": "678-935-9567",
            "fax_number": "678-935-9568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBA",
        "first_name": "YOSHITARO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-09-02",
        "last_updated": "2026-04-02",
        "certification_date": "2026-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PY004118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Johns Creek, GA
• Providers in Johns Creek, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.