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Contact Information

RUSSELL W LAKE, MD
10055 FORD AVENUE
SUITE 3A
RICHMOND HILL, GA31324
 Phone: 912-819-9601
 Fax: 912-819-9605
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for RUSSELL W LAKE · (Male)

NPI Number 1104081082
Status Active
Credentials MD
Entity Individual
Enumeration date 07/21/2008
Last updated 10/19/2021 - About 5 years ago
Sole proprietor 1 Yes
Identifiers
  • GA License # 75198
  • SC License # 31545
  • GA Medicaid 003213522B
  • GA Medicaid 200480198D
Hospital affiliation(s)
  • CANDLER HOSPITAL - (Acute Care)
    5353 REYNOLDS STREET
    SAVANNAH, GA 31412
  • ST JOSEPH'S HOSPITAL - SAVANNAH - (Acute Care)
    11705 MERCY BOULEVARD
    SAVANNAH, GA 31419
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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