It has an interchange with I-26/US 19W/US 23 before continuing along East Main Street and Elizabethton Highway as it leaves the city.

[1] In Elizabethton, it meets US 321/SR 67/SR 362, and runs concurrent with US 321 along West Elk Avenue and Broad Street through the city's downtown area.

It then turns northward to run concurrent with these highways, crossing the Watauga River via the Gilbert Peters Bridge before splitting off again and continuing northeastward along Stony Creek Road.

Northeast of the Buladeen area, the highway ascends to over 3,500 feet (1,100 m) through a series of switchback curves as it passes over a cross ridge between Holston Mountain and the Irons, where it enters Johnson County.

It continues through a series of gradual ascents and descents across rugged terrain before reaching Laurel Bloomery in the northeastern part of the county.