Idesta Medical Inc

Primary specialty

Phlebotomy TechnicianTaxonomy code 246RP1900X

Legal business name

IDESTA MEDICAL INC

Practice address

1015 Tyrone Rd # 410-C
Tyrone, GA 30290-2407

Phone

(470) 818-2264

Fax

(866) 984-3729

NPI assigned

Jul 27, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Idesta RalphNPI 1205235371

Title

Owner

Phone

(239) 895-7910

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Idesta Ralph

  • Phlebotomy Technician
  • Tyrone, GA
  • NPI 1205235371
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781049600000",
    "number": "1063185015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4827 OLD NATIONAL HWY UNIT 2032",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303376234",
            "telephone_number": "239-895-7910",
            "fax_number": "866-984-3729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 TYRONE RD # 410-C",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302902407",
            "telephone_number": "470-818-2264",
            "fax_number": "866-984-3729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDESTA MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-27",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A",
        "authorized_official_last_name": "RALPH",
        "authorized_official_first_name": "IDESTA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "239-895-7910"
    },
    "taxonomies": [
        {
            "code": "207ZB0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Blood Banking & Transfusion Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "246RP1900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sonja Regina Hill, MT
• Harriet Carleen Hint, CPNP
• Luke Hoelle, PHARMD
• Holistic International Ministries (Dba, Him.,Inc.)
• Maranda Lynn Holmes, LPC
• Jennifer Igieobo
• Nneka Kate Ikwuakolam, RBT
• Immediate Care Centers of Georgia, LLC
• Independent Physical Therapy of Ga, LLC
• Farhan Islam

• Phlebotomy Technician in Tyrone, GA
• Providers in Tyrone, GA by specialty
• Phlebotomy Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.