DR. RUSSELL LAKE, MD

Family Medicine

Active Individual
NPI: 1104081082

Practice Address

10055 FORD AVENUE
SUITE 3A
Richmond Hill, GA 31324

Phone: (912) 819-9601

Specialties

Specialty Code Primary License
Family Medicine 207Q00000X Yes 75198 (GA)

Frequently Asked Questions

NPI 1104081082 is the National Provider Identifier for DR. RUSSELL LAKE, MD, a Family Medicine provider located in Richmond Hill, GA. This NPI was enumerated on July 21, 2008.
DR. RUSSELL LAKE, MD practices at 10055 FORD AVENUE, SUITE 3A, Richmond Hill, GA 31324.

Quick Facts

NPI
1104081082
Type
Individual
Enumerated
Jul 21, 2008
Last Updated
Oct 19, 2021

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