MEDICARE: KHAN BABA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1558204644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KHAN BABA LLC

Provider Business Mailing Address
First Line	:	1858 STONEBROOK WAY
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-2933
Country	:	US
Telephone Number	:	501-208-8006
Fax Number	:	213-449-3733

Provider Business Practice Location Address
First Line	:	1858 STONEBROOK WAY
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-2933
Country	:	US
Telephone Number	:	501-208-8006
Fax Number	:	213-449-3733

Authorized Official
Title or Position	:	MANAGER
Name	:	HARIS KHAN
Credential	:
Telephone Number	:	501-208-8006

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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Directions to “KHAN BABA LLC ” Practice Location

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