Provider Demographics
NPI:1982005674
Name:LANG, TAMIKA RENEE (MHS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TAMIKA
Middle Name:RENEE
Last Name:LANG
Suffix:
Gender:F
Credentials:MHS, PA-C
Other - Prefix:MS
Other - First Name:TAMIKA
Other - Middle Name:RENEE
Other - Last Name:DICKENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS, PA-C
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:1530 DRAYTON ROAD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1058
Practice Address - Country:US
Practice Address - Phone:864-560-6012
Practice Address - Fax:864-560-6013
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017971363A00000X
SC2526363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2582PAMedicaid
SCSC81565019OtherMEDICARE PIN
SC2582PAMedicaid