| Dr Russell William Lake, MD | |
|
10055 Ford Avenue, Suite 3a, Richmond Hill, GA 31324 | |
| (912) 819-9601 | |
| (912) 819-9605 |
| Full Name | Dr Russell William Lake |
|---|---|
| Gender | Male |
| Speciality | Family Practice |
| Experience | 18 Years |
| Location | 10055 Ford Avenue, Richmond Hill, Georgia |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104081082 | NPI | - | NPPES |
| 200480198D | Medicaid | GA | |
| 003213522B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 31545 (South Carolina) | Secondary |
| 207Q00000X | Family Medicine | 75198 (Georgia) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| St Joseph's/ Candler Home Healthcare | Hinesville, GA | Home health agency |
| Amedisys Home Health | Savannah, GA | Home health agency |
| St Joseph's Hospital - Savannah | Savannah, GA | Hospital |
| Candler Hospital | Savannah, GA | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Sjc Medical Group Inc | 7719978105 | 49 |
| Entity Name | Sjc Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1811233828 PECOS PAC ID: 7719978105 Enrollment ID: O20040524000690 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Russell William Lake, MD 836 E. 65th Street, Suite 22, Savannah, GA 31405 Ph: (912) 819-7878 | Dr Russell William Lake, MD 10055 Ford Avenue, Suite 3a, Richmond Hill, GA 31324 Ph: (912) 819-9601 |
Jerrod Anderson, Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 3866 Belfast Keller Rd Ste 102, Richmond Hill, GA 31324 Phone: 912-819-9620 Fax: 912-819-9621 | |
Daniel Aaron Brody, D.O. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 3776 Us Highway 17, Richmond Hill, GA 31324 Phone: 912-350-7020 | |
Dr. Grant Allan Foster, M.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 58 Grace Ct, Richmond Hill, GA 31324 Phone: 912-727-3393 | |
Dr. Deronda Felicia Brown, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 1604 River Oaks Dr, Richmond Hill, GA 31324 Phone: 912-445-5183 Fax: 912-445-5183 | |
Rebecca Marshburn Sellers, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 89 Interchange Dr, Richmond Hill, GA 31324 Phone: 912-527-5301 Fax: 912-756-4740 | |
Catherine Elizabeth Waldron, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 89 Interchange Dr, Richmond Hill, GA 31324 Phone: 912-527-5301 Fax: 912-756-4740 |