MEDICARE: RACINE M WABWENDE APRN PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN-NP713696	GA

General Provider Information

NPI Number	:	1417897950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACINE M WABWENDE APRN PMHNP-BC

Provider Business Mailing Address
First Line	:	367 BAYMIST DR
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-9056
Country	:	US
Telephone Number	:	312-383-3680
Fax Number	:	312-383-3680

Provider Business Practice Location Address
First Line	:	367 BAYMIST DR
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-9056
Country	:	US
Telephone Number	:	312-383-3680
Fax Number	:	312-383-3680

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2026
Last Update Date	:	04/01/2026

Similar Medicare Providers

1447192752 — NANJUWETTE EDWARDS CFNC, BCHHP
Practice Location Address:

910 ATHENS HWY STE 305
LOGANVILLE, GA
30052-4952

Practice Phone: 917-841-1847
Practice Fax:

1902637051 — MR. PROSPER C EMEKA PMHNP
Practice Location Address:

339 BLUE JUNIPER CIR
LOGANVILLE, GA
30052-6539

Practice Phone: 770-369-7248
Practice Fax:

1326610486 — SET IN MOTION PT, LLC
Practice Location Address:

129 LEE BYRD RD
LOGANVILLE, GA
30052-2310

Practice Phone: 678-750-3330
Practice Fax:

1952243610 — CHESNEY CONANT
Practice Location Address:

4385 PECAN ST
LOGANVILLE, GA
30052-2637

Practice Phone: 678-232-0022
Practice Fax:

1679577936 — DR. PONNIE DAVIS POISAL DMD
Practice Location Address:

3973 ATLANTA HWY , STE 100
LOGANVILLE, GA
30052-3750

Practice Phone: 770-466-3114
Practice Fax: 770-466-3777

1174521868 — MR. THOMAS CHRISTOPHER WILSON PT
Practice Location Address:

3455 HIGHWAY 81 SOUTH
LOGANVILLE, GA
30052-3918

Practice Phone: 678-635-8280
Practice Fax: 678-635-8285

Directions to “ RACINE M WABWENDE APRN PMHNP-BC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.