Healthcare Provider Details

I. General information

NPI: 1376860924
Provider Name (Legal Business Name): JENNA WALTERS LAMBETH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA LEIGH WALTERS MD

II. Dates (important events)

Enumeration Date: 04/22/2010
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 SPRUCE ST STE 209
BELMONT NC
28012-3386
US

IV. Provider business mailing address

1212 SPRUCE ST STE 209
BELMONT NC
28012-3386
US

V. Phone/Fax

Practice location:
  • Phone: 704-862-4700
  • Fax: 704-862-4749
Mailing address:
  • Phone: 704-862-4700
  • Fax: 704-862-4749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD48098
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number38755
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number201500648
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number201500648
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: