Healthcare Provider Details

I. General information

NPI: 1538086863
Provider Name (Legal Business Name): RAEGAN WEDIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 W WHEELER PKWY
AUGUSTA GA
30909-1899
US

IV. Provider business mailing address

904 RAGHORN RD
GROVETOWN GA
30813-2295
US

V. Phone/Fax

Practice location:
  • Phone: 706-863-1188
  • Fax:
Mailing address:
  • Phone: 810-790-0538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP311810
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: