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

Jack Russelle Lake, DO

Individual provider Diagnostic Radiology Physician · NPI 1932248101

Jack Russelle Lake, DO is a Diagnostic Radiology in Albany, Georgia. Qualified in 2003, 23 years ago. Practices with South Jersey Radiology Associates P A, a 200-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Georgia and Oklahoma.

Years since qualifying
23
Licensed in
GA, OK
In the registry since
2007
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

2624 Dawson Rd
Albany, GA 31707-1609
Phone: (229) 888-1624
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 940 Ne 13th St, Oklahoma City, OK 73104-5008 — (405) 271-5125

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence 4205 (OK)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 101304 (GA)

Record details

NPI number1932248101
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedFebruary 5, 2007
Last updated in NPPESOctober 30, 2024
Certification dateOctober 30, 2024
Mailing address700 E Morehead St Ste 300, Charlotte, NC 28202-2742

Medicare enrollment

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

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolOTHER
Graduated 2003 (23 years in practice)
Group practice South Jersey Radiology Associates P A — 200 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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