Individual
DR. DAVID WAYNE LARISCY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1058 BERMUDA RUN, STATESBORO, GA 30458-0858
(912) 243-9274
(912) 341-6513
Mailing address
103 WINDY HILL CT, STATESBORO, GA 30458-9139
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
074285
GA
207UN0901X
Nuclear Cardiology Physician
074285
GA
208M00000X
Hospitalist Physician
56424
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003172897
—
GA
Enumeration date
04/13/2009
Last updated
03/13/2023
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