It primarily connects small towns in the central Piedmont region of the state.

[1][2] After crossing into Richmond County, NC 109 intersects Grassy Island Road (SR 1634).

When the road enters Mount Gilead on Wadesboro Boulevard, it intersects NC 731 and then bypasses downtown.

About a mile after leaving Mount Gilead the road enters the Uwharrie National Forest.

In Troy, NC 109 turns left to continue back north along N Bilhen Street.

The road was extended to its final southern terminus at the South Carolina state line.

NCDOT conducted a project study to improve the safety of NC 109 between Thomasville and Winston-Salem in 2012.

On November 1, 2024, NCDOT certified the decommissioning of the business route, with Smitherman and Eldorado streets downgraded to secondary road (SR 1412).