Individual
IDESTA RALPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1015 TYRONE RD # 410-C, TYRONE, GA 30290-2407
(470) 818-2264
(866) 984-3729
Mailing address
5530 OLD NATIONAL HWY BLDG 5530-B2, COLLEGE PARK, GA 30349-6234
(470) 818-2264
(866) 984-3729
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
56083
NY
Other
Enumeration date
08/14/2014
Last updated
06/10/2026
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