=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801746995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOUBA COMMERCE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2026
-----------------------------------------------------
Last Update Date | 01/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 605 LINCOLN COURT AVE NE
-----------------------------------------------------
City | BROOKHAVEN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30329-1818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-397-7479
-----------------------------------------------------
Fax | 802-397-7479
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 605 LINCOLN COURT AVE NE
-----------------------------------------------------
City | BROOKHAVEN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30329-1818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-397-7479
-----------------------------------------------------
Fax | 802-397-7479
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SALIYA TALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 802-397-7479
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------