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Russell Lake, MD
NPI 1104081082 · on the registry since 2008 · sole proprietor
Practice
- Address
- 10055 Ford Avenue
Suite 3a
Richmond Hill, GA 31324 - Phone
- (912) 819-9601
- Fax
- (912) 819-9605
- Organisation at this address
- Coastal Community Health Services, Inc.
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 16
Registry record
- Primary taxonomy
- Family Medicine Physician
207Q00000X
- Also registered as
- Family Medicine Physician
- Licence states on file
- SC, GA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2021-10-19
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Georgia