Individual
DOMINIC DWAYNE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 W OAK ST, CARBONDALE, IL 62901-1400
(217) 891-9662
Mailing address
300 W OAK ST, CARBONDALE, IL 62901-1400
(217) 891-9662
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
05/21/2025
Last updated
05/21/2025
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