It serves as the main road through Hookerton and an alternate bypass of Snow Hill, entirely in Greene County.

2.4 miles (3.9 km) from NC 58, it enters the town of Hookerton where it goes north along William Hooker Drive then east on Main Street.

Crossing the Contentnea Creek, it continues north to Maury, where it connects with NC 903.

[1] The routing makes it an optional bypass of Snow Hill, for those traveling between Kinston and Farmville; however, speed limit drops to 35 miles per hour (56 km/h) in both Hookerton and Maury, so any time save is minimal.

NC 123 was established in 1932 as a new primary spur from US 258/NC 12 in Glenfield Crossroads, to the town of Hookerton.