Provider Demographics
NPI:1316553274
Name:YOSHITARO OBA, PH.D., P.C.
Entity Type:Organization
Organization Name:YOSHITARO OBA, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YOSHITARO
Authorized Official - Middle Name:
Authorized Official - Last Name:OBA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:816-217-1254
Mailing Address - Street 1:2308 PERIMETER PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1316
Mailing Address - Country:US
Mailing Address - Phone:770-457-5577
Mailing Address - Fax:770-457-5599
Practice Address - Street 1:2308 PERIMETER PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1316
Practice Address - Country:US
Practice Address - Phone:770-457-5577
Practice Address - Fax:770-457-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003194485AMedicaid