Healthcare Provider Details

I. General information

NPI: 1063146157
Provider Name (Legal Business Name): BRUKE ZELEKE ABENET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HEMLOCK ST
MACON GA
31201-2102
US

IV. Provider business mailing address

3780 EISENHOWER PKWY
MACON GA
31206-0800
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number103203
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101284523
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: