Provider Demographics
NPI:1699776906
Name:LAKE, FRANK (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:LAKE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-535-3393
Practice Address - Fax:770-503-0579
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0119722085R0001X
GA119722085H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085H0002XAllopathic & Osteopathic PhysiciansRadiologyHospice and Palliative Medicine
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00116168AMedicaid
D30008Medicare UPIN