Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DOMINIC DWAYNE JOHNSON
ActiveDOMINIC DWAYNE JOHNSON is a Community Health Worker healthcare provider located in CARBONDALE, Illinois. NPI 1104618529 is currently active in the NPPES registry. Verify at CMS.
Community Health Worker · CARBONDALE, IL
Registration Details
- NPI Number
- 1104618529
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- May 21, 2025 (1.2096084548962 yrs)
- Last Updated
- May 21, 2025
Practice Information
- Address
-
300 W OAK STCARBONDALE, IL, 629011400Browse IL providers · Browse ZIP 62901
- Phone
- 2178919662
- Primary Specialty
-
Community Health Worker
172V00000X
Other Community Health Worker Providers in CARBONDALE, IL
| Name | Credential | NPI |
|---|---|---|
| MR. OTIS JAMES DUNCAN | MA | 1649060815 |
| DEANDRE LOVE | — | 1346031994 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.