DR. Russell William Lake, MD
NPI #1104081082 in Richmond Hill, Georgia
Provider Information
- NPI Number
- 1104081082
- Entity Type
- Individual
- Name
- DR. Russell William Lake, MD
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Family Medicine
- Credential
- MD
- Enumeration Date
- Jul 21, 2008
- Last Updated
- Oct 19, 2021
Practice Location
- Address
- 10055 FORD AVENUE
- Address 2
- SUITE 3A
- City
- Richmond Hill
- State
- Georgia
- ZIP Code
- 31324
- Phone
- (912) 819-9601
Specialties & Taxonomy Codes
| Specialty |
|---|
| Family Medicine |
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