Provider Demographics
NPI:1376860924
Name:LAMBETH, JENNA WALTERS (MD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:WALTERS
Last Name:LAMBETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LEIGH
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1212 SPRUCE ST STE 209
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3386
Mailing Address - Country:US
Mailing Address - Phone:704-862-4700
Mailing Address - Fax:704-862-4749
Practice Address - Street 1:1212 SPRUCE ST STE 209
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3386
Practice Address - Country:US
Practice Address - Phone:704-862-4700
Practice Address - Fax:704-862-4749
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD48098207LP2900X
SC38755207LP2900X, 207LP2900X
NC201500648208VP0000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine