IDESTA RALPH
NPI 1205235371
Technician, Pathology - Phlebotomy in Tyrone, GA
Active since August 14, 2014
About Idesta Ralph NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
IDESTA RALPH (NPI 1205235371) is an individual phlebotomy provider in Tyrone, Georgia, licensed in New York (56083) and active in the NPI registry since August 2014.
NPPES Registry Identity
NPI1205235371
Entity TypeIndividualFemale
Primary Taxonomy246RP1900X
Provider Legal NameIDESTA RALPH
Location Address1015 TYRONE RD # 410-CTyrone, GA 30290-2407
Mailing Address5530 Old National Hwy Bldg 5530-b2College Park, GA 30349-6234 · (470) 818-2264 · Fax (866) 984-3729
Phone(470) 818-2264
Fax(866) 984-3729
Sole ProprietorYes
Enumeration DateAugust 14, 2014
Last NPPES UpdateJune 10, 20262 updates tracked since enumeration
NPPES CertifiedJune 10, 2026
✔ NPI 1205235371 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyTechnician, Pathology · PhlebotomyTechnologists, Technicians & Other Technical Service Providers
Taxonomy Code246RP1900X
License✔ Licensed in NY · 56083
1015 TYRONE RD # 410-C, Tyrone, GA 30290
Other Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1205235371, enumerated as an "individual" on August 14, 2014.
The provider is located at 1015 TYRONE RD # 410-C TYRONE, GA 30290 and the phone number is (470) 818-2264.
Technician, Pathology with taxonomy code 246RP1900X and a focus in Phlebotomy.
