Edward Gerard Buckenham III, MA, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC006095 Issued in GA

Practice address

104 E 5TH Ave
Rome, GA 30161-3128

Phone

(706) 235-6990

NPI assigned

Dec 6, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1710160320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 ROYAL OAK DR NE",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301659331",
            "telephone_number": "706-295-0440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 E 5TH AVE",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301613128",
            "telephone_number": "706-235-6990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Royal Oak Dr NE",
            "address_purpose": "LOCATION",
            "city": "Rome",
            "state": "GA",
            "postal_code": "301659331",
            "country_code": "US",
            "telephone_number": "706-204-9303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUCKENHAM",
        "first_name": "EDWARD",
        "middle_name": "GERARD",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "MA, LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-06",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "APC001620",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC006095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Gaylor Broyles, LPC
• McKenzi Paige Brumby, WHNP-BC
• Starla Kay Brumit Chandler, NP-C
• Ashley Eugenia Bryan, DNP
• Cynthia Bryan, RN
• Brenda D. Budlong, M.D.
• Howard Kelly Buffington, FNP-C
• Joseph John Burch, M.D.
• Joseph Samuel Burch, MD
• Mary Catherine Burch, FNP

• Professional Counselor in Rome, GA
• Providers in Rome, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.