After briefly serving as the northern perimeter for the Uwharrie National Forest, it splits with NC 49 and goes north to Southmont.

On the north side of Lexington, it connects with I-85 Business/US 29/US 64/US 70 before pressing on along Winston Road to Welcome, where it begins its longest concurrency with US 52.

With US 52, it bypasses east of Welcome and west of Midway before entering Winston-Salem, where the freeway becomes known as the North-South Expressway.

With a brief concurrency with US 311, it eventually splits from US 52 at Germanton Road, where it continues along north as a two-lane rural highway.

NC 8 was established in 1930 as a new primary routing from Lexington, 5 miles (8.0 km) south to the Junior Order United American Mechanics (JOUAM) children's home, located near High Rock Lake.

In 1967, NC 8 northbound was rerouted on a short concurrency with US 158/US 421 then north along a completed section of the North-South Freeway; NC 8 southbound remained unchanged until 1973, when the rest of the North-South Expressway was completed, eliminating its routing through downtown Winston-Salem.