Healthcare Provider Details

I. General information

NPI: 1306645072
Provider Name (Legal Business Name): JORGE CARRANZA MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JOSEPH E LOWERY BLVD NW
ATLANTA GA
30314-3421
US

IV. Provider business mailing address

80 JOSEPH E LOWERY BLVD NW
ATLANTA GA
30314-3421
US

V. Phone/Fax

Practice location:
  • Phone: 404-996-2171
  • Fax:
Mailing address:
  • Phone: 404-996-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC016669
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: