NPI 1063185015

Idesta Medical INC

Organisation Phlebotomy Technician Tyrone, GA

Practice location

Address: 1015 Tyrone Rd # 410-C, Tyrone, GA 30290-2407
Phone: (470) 818-2264
Fax: (866) 984-3729
Mailing address: 4827 Old National Hwy Unit 2032, College Park, GA 30337-6234

Authorised official

Name: Idesta Ralph
Title: Owner
Phone: (239) 895-7910

Registered specialties (3)

Phlebotomy Technician Primary

Technologists, Technicians & Other Technical Service Providers Taxonomy 246RP1900X

Other Technician, Pathology providers in Georgia →

Blood Banking & Transfusion Medicine Physician

Allopathic & Osteopathic Physicians Taxonomy 207ZB0001X

Other Pathology providers in Georgia →

Clinic/Center

Ambulatory Health Care Facilities Taxonomy 261Q00000X

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Registry record

NPI: 1063185015
Entity type: Organization
NPI issued: 27 Jul 2021
Record last updated: 10 Jun 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.