Provider Demographics
NPI:1386240844
Name:WILLIAMSON, DOUGLAS LOGAN (DNP)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LOGAN
Last Name:WILLIAMSON
Suffix:
Gender:
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 ELLA ST STE B
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4166
Mailing Address - Country:US
Mailing Address - Phone:805-541-6000
Mailing Address - Fax:805-541-6001
Practice Address - Street 1:1304 ELLA ST STE B
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4166
Practice Address - Country:US
Practice Address - Phone:805-541-6000
Practice Address - Fax:805-541-6001
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95016180163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty