The two-lane roads heads east through a mostly forested area of the county, staying between one to one and a half miles (1.6 to 2.4 km) north of the Roanoke Rapids Lake shoreline.

At the intersection of River Road, North Carolina Bicycle Route 4 joins to form a concurrency with NC 46 from here to Gaston.

The road resumes a more rural surrounding again as it passes some farms, small homes, and light industrial businesses.

In the vicinity of I-95's exit 176, a diamond interchange, there are few traveler services in the immediate vicinity—only one each of a gas station, restaurant, and motel.

After a short stretch of road in a rural area, NC 46 enters Garysburg passing through a mainly residential section of the town before it ends at a stop-controlled T-intersection with U.S. Route 301 (US 301).