Provider Demographics
NPI:1376399642
Name:VITALEDGE LLC
Entity type:Organization
Organization Name:VITALEDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:TROYER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:470-877-4764
Mailing Address - Street 1:2581 HIGHWAY 54 STE B3
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3528
Mailing Address - Country:US
Mailing Address - Phone:770-714-3106
Mailing Address - Fax:
Practice Address - Street 1:2581 HIGHWAY 54 STE B3
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3528
Practice Address - Country:US
Practice Address - Phone:770-714-3106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-27
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center