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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-695-6697
Mailing Address - Fax:
Practice Address - Street 1:701 GROVE RD FL 5
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4210
Practice Address - Country:US
Practice Address - Phone:864-455-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2025-09-15
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