Mary Susan Shaw Tolbert, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA0000001709 Issued in TN

Practice address

Building C-1722
Tagatay and Gruber Rd.
Fort Bragg, NC 28310-0001

Phone

(910) 907-8282

Fax

(910) 907-9360

NPI assigned

Nov 16, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mary Susan Shaw Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cornerstone Family Physicians

  • Family Medicine Physician
  • Lakewood, WA
  • NPI 1700830213
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1790767705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1511 DONELSON PKWY",
            "address_2": "WOMACK ARMY MEDICAL CENTER",
            "city": "DOVER",
            "state": "TN",
            "postal_code": "370583749",
            "telephone_number": "910-907-8922",
            "fax_number": "910-907-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BUILDING C-1722",
            "address_2": "TAGATAY AND GRUBER RD.",
            "city": "FORT BRAGG",
            "state": "NC",
            "postal_code": "283100001",
            "telephone_number": "910-907-8282",
            "fax_number": "910-907-9360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOLBERT",
        "first_name": "MARY SUSAN",
        "middle_name": "SHAW",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-16",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "PA0000001709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7044670",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "SHAW",
            "middle_name": "SUSAN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sherry Threlkeld
• David Thurber
• Jennifer Ann Tiffany, CNM, WHNP-BC
• Stephen Thomas Tipton, OD
• Caitlin Eliza Toffler, M.D
• Crystal Toone
• Shane Topf, DO
• Ashley Torrence, CRNA
• Cheryl Sutton Torres, MSW, LCSW
• William Townsend, CRNA

• Physician Assistant in Fort Bragg, NC
• Providers in Fort Bragg, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.