Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dominic Dwayne Johnson

Individual provider Community Health Worker · NPI 1104618529

Dominic Dwayne Johnson is a Community Health Worker in Carbondale, Illinois. Registered with an NPI since 2025.

In the registry since
2025

Practice location Address checks out

300 W Oak St
Carbondale, IL 62901-1400
Phone: (217) 891-9662
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Community Health Worker (primary) Taxonomy 172V00000X

Record details

NPI number1104618529
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 21, 2025
Last updated in NPPESMay 21, 2025
Certification dateMay 21, 2025
Mailing address300 W Oak St, Carbondale, IL 62901-1400

Other providers in Carbondale