Idesta Ralph

Primary specialty

Phlebotomy TechnicianTaxonomy code 246RP1900X

License

56083 Issued in NY

Practice address

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

Phone

(470) 818-2264

Fax

(866) 984-3729

NPI assigned

Aug 14, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Idesta Medical Inc

  • Phlebotomy Technician
  • Tyrone, GA
  • NPI 1063185015
  NPD Authorized official

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

{
    "created_epoch": "1407974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781049600000",
    "number": "1205235371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5530 OLD NATIONAL HWY BLDG 5530-B2",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303496234",
            "telephone_number": "470-818-2264",
            "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": {
        "last_name": "RALPH",
        "first_name": "IDESTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-14",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246RP1900X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": "NY",
            "license": "56083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kristin M Railey
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• Elizabeth Ream, MA, LPC
• Juliane Simone Reynolds, D.D.S.
• Roseann Rhoda, RPH
• Jeneen Ridgeway, D.C.

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.