Originally established as the state's central highway, from Murphy to Beaufort, it now serves to connect the city of Newton with the nearby communities and towns in the foothills region.

Once it crosses US 70, NC 10 reaches its eastern terminus at Interstate 40 (exit 138) in Catawba County, just southwest of Statesville.

NC 10 was initially part of the great Central Highway and designated as an original numbered state route in 1921.

This was by no means a highway in any practical sense of the word, but was only a projected route for travel through the state.

The route was to begin at Morehead City and go through the state from east to west by way of Raleigh, Greensboro, Salisbury and Asheville.

[2][3] But the Central Highway followed its sweeping curves and even today [1931] the magnificent state route number 10 takes the same roundabout course from the seashore to the Tennessee line.

In 1911 a Central Highway Committee was appointed with the function of designating the route in detail, and getting the various counties to cooperate in building it through from one end of the state to the other.

Every year the committee made a trip over the route, traveling by automobile, exhorting the people to good works and telling them what the other counties were doing.

In 1921, Governor Cameron Morrison, along with the state legislature, backed a $50 million bond for a state-owned and maintained highway system, launching North Carolina's first organized statewide road and bridge improvement campaign.

NC 10 was also known as the "Old Hickory Highway;" at the North Carolina State Capitol building there is a granite highway marker commemorating the North Carolina soldiers of the U.S. Army's 30th "Old Hickory" Division, who fought to break the Hindenburg Line in France during World War I.

After Bryson City, the road went to Ela, followed Hwy 19A along the Tuckasegee River, and then essentially followed current US 74 to Asheville from there.

NC 10 continued through Nebo (along Memorial Park Road and Old Hwy 10E), Marion, Morganton, and then into Hickory (along US 70A).

Once leaving Hickory, NC 10 then passed through Conover, Catawba, Statesville, Salisbury, across the Yadkin River on the Wil-Cox Bridge (It is still in use with US 29), Lexington, through Thomasville and High Point.

NC 10 ran from Greensboro to Elon College, Burlington, Graham, and entered Hillsborough on a parallel route east just north of the current interstate on Ben Johnson Road.

The road followed the Eno River to Hillsborough and turned left on King Street (which no longer is an intersection).

NC 10 left Raleigh and then passed through Smithfield, Princeton, Goldsboro, La Grange, Kinston, New Bern, Havelock, and terminated in Beaufort.

A short distance after Marion, there is a segment which exits left from US 70 (now Memorial Park Road), curves and winds to the northeast, then southeast to Nebo, where it reconnects to US 70.