Provider Demographics
NPI:1528030947
Name:LAKE, FRANCIS T JR (MD)
Entity Type:Individual
Prefix:MR
First Name:FRANCIS
Middle Name:T
Last Name:LAKE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FRANK
Other - Middle Name:T
Other - Last Name:LAKE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1094 BERMUDA RUN
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0858
Mailing Address - Country:US
Mailing Address - Phone:912-681-3111
Mailing Address - Fax:912-681-3461
Practice Address - Street 1:1094 BERMUDA RUN
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0858
Practice Address - Country:US
Practice Address - Phone:912-681-3111
Practice Address - Fax:912-681-3461
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040716207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
16BDTXDMedicare ID - Type Unspecified
G69334Medicare UPIN