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SOUTHERN SHORES FAMILY CARE LLC
NPI 1972479541
Family Medicine in Richmond Hill, GA

Active since October 13, 2025CLIA 11D2334779 · Waiver
2658 US HIGHWAY 17, RICHMOND HILL, GA 31324(912) 356-9900(912) 550-3094 Get Directions Write a Review

NPPES record last updated: April 10, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Apr 10, 2026, Nov 5, 2025 (2 updates tracked since 2025).

About Southern Shores Family Care Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHERN SHORES FAMILY CARE LLC (NPI 1972479541) is a healthcare organization registered as a family medicine in Richmond Hill, Georgia and active in the NPI registry since October 2025. The organization holds a CLIA Waiver certificate valid through December 1, 2027 and lists Kristina Johnson, Owner, as its authorized official.

NPPES Registry Identity

NPI1972479541
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameSOUTHERN SHORES FAMILY CARE LLC
Location Address2658 US HIGHWAY 17Richmond Hill, GA 31324-3374
Mailing Address2658 Us Highway 17Richmond Hill, GA 31324-3374 · (912) 356-9900 · Fax (912) 445-6012
Phone(912) 356-9900
Fax(912) 550-3094
Organization SubpartNo
Authorized OfficialKristina JohnsonOwner · (912) 550-3094
Enumeration DateOctober 13, 2025
Last NPPES UpdateApril 10, 20262 updates tracked since enumeration
NPPES CertifiedApril 10, 2026
✔ NPI 1972479541 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
2658 US HIGHWAY 17, Richmond Hill, GA 31324
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Southern Shores Family Care Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Southern Shores Family Care LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Kristina Johnson, M.D.
Family Practice
NPI 1841426707
2658 US HIGHWAY 17
Richmond Hill, GA 31324
(912) 356-9900
✔ PECOS✔ Accepts MedicareSame address
Alexandra Ruiz
Nurse Practitioner
NPI 1538557061
3505 DULUTH PARK LN STE 400
Duluth, GA 30096
(678) 597-3180
✔ PECOS✔ Accepts Medicare218 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2334779

Southern Shores Family Care LLC · Richmond Hill, GA
Active · expires Dec 1, 2027
CLIA Number11D2334779
Laboratory TypePhysician Office
Certificate Effective DateDecember 2, 2025
Certificate Expiration DateDecember 1, 2027
Laboratory DirectorKristina Johnson
Laboratory Phone(912) 356-9900
Laboratory LocationSouthern Shores Family Care LLC2658 Highway 17 South, Richmond Hill, GA 31324
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Shores Family Care LLC's NPI number?

The NPI number for Southern Shores Family Care LLC is 1972479541. It was assigned to this organization in the NPPES registry on October 13, 2025.

Where is Southern Shores Family Care LLC located?

Southern Shores Family Care LLC is located at 2658 Us Highway 17, Richmond Hill, GA 31324. The listed phone number is (912) 356-9900.

What is Southern Shores Family Care LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Southern Shores Family Care LLC enrolled in Medicare?

Yes. Southern Shores Family Care LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southern Shores Family Care LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Southern Shores Family Care LLC, in Family Practice and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Southern Shores Family Care LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2334779) is associated with this NPI, valid through December 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Southern Shores Family Care LLC was last updated on April 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.