SR 44 begins as a 2-lane highway in Bluff City at an intersection with US 11E/US 19W/SR 34 just south of that route's interchange with US 19E/SR 37, where US 19E and 19W merge to form US 19.

The highway then parallels the South Fork Holston River and a rail road track before having an intersection with SR 390, where it breaks away from the former route of US 11E/US 19 to follow its own path.

SR 44 then passes through the center of town before leaving Bluff City and going east, still paralleling the Houston River.

SR 44 then passes through the community of Hickory Tree before crossing the River and turning north via a sharp left at a 4-way stop intersection.

They go east as a 4-lane divided highway to enter Holston Valley where it has an intersection with SR 435, before narrowing to 2-lanes, where leaves US 421/SR 34 and goes north via a Y-Intersection shortly afterwards.