Individual provider Active NPI

Sela Ackerman Hothersall, OD

  • Optometrist
  • Kennesaw, GA
National Provider Identifier
1134023112
Registry record updated Oct 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT003772 Issued in GA
Practice address
1615 Ridenour Blvd NW Ste 201
Kennesaw, GA 30152-4464
Phone
(770) 499-2020
NPI assigned
Oct 5, 2026
Last updated
Oct 5, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 5, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT003772 GA Primary

Addresses

Primary practice location

1615 Ridenour Blvd NW Ste 201
Kennesaw, GA 30152-4464

Mailing address

1615 Ridenour Blvd NW Ste 201
Kennesaw, GA 30152-4464
Phone (770) 499-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI Registry JSON

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

{
    "created_epoch": "1791158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791158400000",
    "number": "1134023112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 RIDENOUR BLVD NW STE 201",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301524464",
            "telephone_number": "770-499-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 RIDENOUR BLVD NW STE 201",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301524464",
            "telephone_number": "770-499-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOTHERSALL",
        "first_name": "SELA",
        "middle_name": "ACKERMAN",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-10-05",
        "last_updated": "2026-10-05",
        "certification_date": "2026-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT003772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennesaw, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.