NPI age
19 years
Enumerated 2007-02-05
● Active
Type 1 · Individual
Jack Russelle Lake, D.O.
Lake is 1 of 13 radiology providers in Albany and 1 of 1280 in Georgia.
Primary specialty
Radiology
Plus 1 subspecialty
Licensed in
OK, GA
2 states
Status
Active
No deactivations on record
Last NPPES update
2024-10-30
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 1280 active radiology providers in Georgia.
NPI age
19 years
≈ at median (19 yr)
State licenses
2 states
Top 78% — 21% of peers are multi-state
Subspecialties
0
38% of peers hold subspecialties
NPI lifetime · 2007 → 2026
2007-02Enumerated in NPPES
2007
2026
Where they practice
Practice location
2624 Dawson Rd
Albany, GA 317071609
Mailing address
700 E Morehead St Ste 300
Charlotte, NC 282022742
Additional practice locations
1 secondary location on file with NPPES.
Location 2
940 Ne 13th St, 4g4250
Oklahoma City, OK 731045008
Specialties
-
Radiology PrimaryA radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Practice context
Part of a multi-provider practice. 7 other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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