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General NPI Number Information
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NPI Number | 1447073085
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Entity Type | Organization
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Legal Business Name | VITALEDGE HEALTH & WELLNESS
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 2581 HIGHWAY 54 STE B3
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3528
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Country | US
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Telephone | 770-714-3106
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Fax |
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Provider Business Mailing Address
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Address Line | 2581 HIGHWAY 54 STE B3
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3528
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Country | US
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Telephone | 770-714-3106
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. PEGGY DARLENE TROYER
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Credential | FNP-C
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Telephone | 770-714-3106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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