Healthcare Provider Details

I. General information

NPI: 1104831072
Provider Name (Legal Business Name): SEVDALINA METODIEVA DABOVA-MISSOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINA M MISSOVA MD

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 JOHNS HOPKINS DR
GREENVILLE NC
27834-2056
US

IV. Provider business mailing address

PO BOX 751069
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-1406
  • Fax: 252-744-2419
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46703
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberME137661
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2024-00056
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number2024-00056
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: