Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Russell William Lake, MD

Individual provider Family Medicine Physician · NPI 1104081082

Dr. Russell William Lake, MD is a Family Practice in Richmond Hill, Georgia. Graduated from Medical University of South Carolina College of Medicine in 2007, 19 years ago. Practices with Sjc Medical Group Inc, a 57-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Georgia and South Carolina.

Years since qualifying
19
Trained at
Medical University of South Carolina College of Medicine
Licensed in
GA, SC
In the registry since
2008
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

10055 Ford Ave Ste 3A
Richmond Hill, GA 31324
Phone: (912) 819-9601
Fax: (912) 819-9605
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 75198 (GA)
Family Medicine Physician Taxonomy 207Q00000X · Licence 31545 (SC)

Record details

NPI number1104081082
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedJuly 21, 2008
Last updated in NPPESOctober 19, 2021
Certification dateOctober 19, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolMEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE
Graduated 2007 (19 years in practice)
Group practice Sjc Medical Group Inc — 57 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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