SR 386 begins at a two-way partial Y interchange with Interstate 65 (I-65) in Davidson County north of Nashville.

The route then curves slightly to the southeast and enters the central part of Hendersonville and has interchanges with SR 258 (New Shackle Island Road), Indian Lake Boulevard, and Saundersville Road, before coming to a partial y interchange with US 31E in what was originally the eastern terminus of the route.

The route that is now SR 386 was originally proposed to provide more convenient means of transportation to Nashville for residents of Hendersonville, which had grown significantly in the 1960s and 1970s.

[4] Beginning in 2003, the highway was extended east to Gallatin in two separate projects after that city experienced further growth and transportation needs.

[7] Also that year the speed limit was reduced from 70 to 65 mph in Sumner County and warning signs were installed around the curve near US 31E in an effort to improve safety on the highway that had developed a high rate of traffic accidents.

[12] In 2012 the chapter worked with the Tennessee General Assembly to install signs along the highway, located each about a half mile apart, that list the names of the 25 Sumner County residents who died in the Vietnam War.