Middlesex is a town in Nash County, North Carolina, United States.

It is part of the Rocky Mount, North Carolina Metropolitan Statistical Area.

According to the United States Census Bureau, the town has a total area of 1.0 square mile (2.6 km2), all land.

There were 426 housing units at an average density of 436.5 per square mile (168.5/km2).

34.6% of all households were made up of individuals, and 18.1% had someone living alone who was 65 years of age or older.