Organization
IDESTA MEDICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IDESTA RALPH (OWNER)
(239) 895-7910
Entity
Organization
Contact information
Practice address
1015 TYRONE RD # 410-C, TYRONE, GA 30290-2407
(470) 818-2264
(866) 984-3729
Mailing address
4827 OLD NATIONAL HWY UNIT 2032, COLLEGE PARK, GA 30337-6234
(239) 895-7910
(866) 984-3729
Taxonomy
Speciality
Code
Description
License number
State
207ZB0001X
Blood Banking & Transfusion Medicine Physician
—
—
246RP1900X
Phlebotomy Technician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
07/27/2021
Last updated
06/10/2026
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