Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JACK RUSSELLE LAKE, D.O.
ActiveJACK RUSSELLE LAKE, D.O. is a Diagnostic Radiology healthcare provider located in ALBANY, Georgia. NPI 1932248101 is currently active in the NPPES registry. Verify at CMS.
Diagnostic Radiology · ALBANY, GA
Registration Details
- NPI Number
- 1932248101
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Feb 5, 2007 (19.484292975003 yrs)
- Last Updated
- Oct 30, 2024
- Licenses
-
101304 (GA)4205 (OK)
Practice Information
- Address
-
2624 DAWSON RDALBANY, GA, 317071609Browse GA providers · Browse ZIP 31707
- Phone
- 2298881624
- Primary Specialty
-
Diagnostic Radiology
2085R0202X
- Additional Specialty
- Diagnostic Radiology
Other Diagnostic Radiology Providers in ALBANY, GA
| Name | Credential | NPI |
|---|---|---|
| WILLIAM B ABBOTT III | MD | 1760489744 |
| ROBERT LEWIS STICKLE | MD | 1255320685 |
| DR. BRENT S DEEM | DO | 1760435416 |
| STEVEN R. ULLRICK | M.D. | 1871536482 |
| DR. GORDON H. TWEDT | M.D. | 1922043009 |
| DR. ROYCE MARLIN CANNINGTON III | MD | 1639268956 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.