MRS. MARY SUSAN SHAW TOLBERT (NPI# 1790767705) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790767705 |
| Entity Type | Individual |
| Full Name | MRS. MARY SUSAN SHAW TOLBERT |
| Other Name | MARY SUSAN SHAW |
| Credential | PA-C |
| Practice Address |
Building C-1722 Tagatay and Gruber Rd. Fort Bragg NC 28310-0001 |
| Mailing Address |
1511 Donelson Pkwy Womack Army Medical Center Dover TN 37058-3749 |
| Practice Telephone | 9109078282 |
| Practice Fax Number | 9109079360 |
| Mailing Telephone | 9109078922 |
| Mailing Fax Number | 9109076069 |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2016-01-25 |
| Gender Code | F |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA0000001709 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7044670 | 05 |
| Street Address |
BUILDING C-1722 TAGATAY AND GRUBER RD. |
| City | FORT BRAGG |
| State | NC |
| Zip Code | 28310-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235129925 | Kathryn Robb O'donnell | Family Medicine | Building C-1722, Tagaytay & Gruber, Fort Bragg, NC 28310-0001 | 2005-10-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013550763 | Brent Francis Bachman | Physician Assistant | 2817 Reilly Street, Fort Bragg, NC 28310 | 2019-10-25 |
| 1417503459 | Cooper Pasque | Dentist | 1838 Normandy Dr., Fort Bragg, Apo, AA 28310 | 2019-08-15 |
| 1851959951 | Daniel Jordan Whitaker | Student in an Organized Health Care Education/Training Program | Womack Army Medical Center, 2817 Reilly Road, Mcxc-cod Credentials, Fort Bragg, NC 28310 | 2019-06-03 |
| 1679054217 | Christopher Cetnar | Dentist | Smokebomb Hill, Bldg 3718 Gruber Road, Fort Bragg, NC 28310 | 2018-08-22 |
| 1316427107 | Alexandrea Lee Clark | Dentist | Laflamme Dental Clinic, Bldg C6238 Ardennes Road, Fort Bragg, NC 28310 | 2018-08-21 |
| 1457843831 | Kevin Patrick Hudson | Student in an Organized Health Care Education/Training Program | 2817 Reilly Road Mxcx - Cod Credentials, Womack Army Medical Center, Fort Bragg, NC 28310 | 2018-06-01 |
| 1639691462 | Margaret S Greene | Dentist | Usa Dental Health Activity Fort Bragg, Wamc Box #151 2817 Rielly Rd, Fort Bragg, NC 28310 | 2017-07-13 |
| 1912432246 | Chezdan Baker | Student in an Organized Health Care Education/Training Program | Us Army Dental Health Activity Bldg-6837 Normandy Drive, Fort Bragg, NC 28310 | 2017-04-24 |
| 1215483094 | Shantryce Monique Boatwright Crump | Dental Hygienist | 2617 Rielly Road, Fort Bragg, NC 28310 | 2016-08-31 |
| 1629435714 | John Gagnier | Physician Assistant | Gruber Road, Building #c-1722, Fort Bragg, NC 28310 | 2016-01-21 |
| Find all providers in zip 28310 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801404496 | Matthew Pace | Physician Assistant | Bldg 5-4257 Bastogne St, Fort Bragg, NC 28303 | 2020-07-20 |
| 1477179869 | Stephen Aaron Reid | Physician Assistant | Robinson Clinic, 1722 Tagatay Dr, Fort Bragg, NC 23807 | 2020-06-22 |
| 1013550763 | Brent Francis Bachman | Physician Assistant | 2817 Reilly Street, Fort Bragg, NC 28310 | 2019-10-25 |
| 1225593411 | Jordan Lamot Houston | Physician Assistant | 1-504 Pir, Fort Bragg, NC 28310-0001 | 2019-02-01 |
| 1720551260 | Henry Elliott White IIi | Physician Assistant | 1-319th Far, Fort Bragg, NC 28310-0001 | 2019-01-08 |
| 1093284465 | Candice Gorremans | Physician Assistant | 108th Air Defense Artillery Brigade, Fort Bragg, NC 28314 | 2018-11-15 |
| 1275016933 | Zarah Pulfrey | Physician Assistant | Womack Medical Center, 2817 Riley Road, Fort Bragg, NC 28217 | 2018-09-10 |
| 1619454980 | Seth David Williams | Physician Assistant | Bldg C-1722 Tagatay Dr, Fort Bragg, NC 28307 | 2018-07-19 |
| 1134633894 | Ashley Andrick | Physician Assistant | 1722 Tagatay Dr, Fort Bragg, NC 28307 | 2017-11-16 |
| 1477005270 | Brittany Lee Howard | Physician Assistant | 2864 Woodruff Street, Fort Bragg, NC 28302 | 2016-10-27 |
| Find all providers in FORT BRAGG | ||||
| City | FORT BRAGG |
| Zip Code | 28310 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.