From the Tennessee state line near Paint Rock to Asheville it follows the historic Dixie Highway, running concurrently with US 25.

The highway connects several major cities including Asheville, High Point, Greensboro, Durham, Raleigh, Goldsboro, and New Bern.

There are a four-lane highway throughout much of the state, and notable sections of US 70 have been converted to freeway or expresway standards, including those in Greensboro, Clayton, and New Ben.

All of US 70 east of Durham, and smaller segments including Statesville to Salisbury and Lexington to Greensboro, are listed in the National Highway System, a network of roads important to the country's economy, defense, and mobility.

In Hot Springs it crosses the French Broad River and the Appalachian Trail, then goes northeasterly through Tanyard Gap to Hurricane.

[7] On the eastern side of Beaucatcher Mountain, US 70/US ;74A goes through a commercial corridor that leads to Asheville Mall, where US 74A splits and continues along South Tunnel Road and connects with I-240 at a unique three-level diamond interchange.

The following 5-mile (8.0 km) descent is a 6% grade along Youngs Ridge to Old Fort, along which are several reduce-speed warning lights and three runaway truck ramps.

At Pleasant Gardens, it connects with NC 80, which travelers can follow towards Mount Mitchell, the highest peak east of the Mississippi River.

Continuing east, it goes through the towns of Drexel, Valdese, Rutherford College, Connelly Springs and Hildebran before crossing into Catawba County at Long View.

[6] After crossing into Rowan County, US 70 goes through Cleveland and shares a short concurrency with NC 801 near Barber before entering Salisbury.

On Jake Alexander Boulevard, US 70 shares a concurrency with US 601 until the Rowan Mills area, where it switches onto Main Street with US 29 and later NC 150.

Entering the Lexington city limits, additional route changes occur; I-285/US 52 departs (at exit 87) towards Winston-Salem, and US 64 merges from Mocksville.

After passing an exit with Westover Terrace, it comes to junction with Battleground Avenue which carries US 220, before the freeway downgrades to partial expressway.

[6][14][15][16] Passing south of Elon, US 70 runs on Church St, a four lane retail corridor, as it enters Burlington's city limits.

Passing through the communities of Miles and Efland, and parallels the NCRR railroad just to the north, US 70 makes a unique median divide in Duke Forest to merge with the I-85 Connector (SR 1239); constructed in the mid-1950s when US 70 was rerouted here onto what is now I-40/I-85.

At Bethesda, Miami Boulevard (SR 1959) continues south into the Research Triangle Park, while US 70 enters Wake County along New Raleigh Highway.

[21] Continuing through Wilson's Mills and crossing the Neuse River, US 70 enters Selma, where travelers have the choice to stay on mainline US 70, connecting with US 301/NC 39/NC 96, I-95, and US 70A, or take US 70 Bypass to avoid all that.

[6][26] Going south, it crosses into Carteret County and then passes west of Newport as it leaves the Croatan National Forest and into Morehead City.

After crossing the Salter's Creek via Dan Taylor Memorial Bridge it connects with NC 12 continuing to Cedar Island and the Outer Banks.

When the highways were signed, the majority of US 70's routing ran along NC 10 which was built from the Georgia state line south of Murphy to Beaufort.

[38] In 1954 US 70 was rerouted onto Woodfin Street in Asheville; placed on its modern alignment between Black Mountain and Old Fort, leaving behind Mill Creek Road (SR 1407)/Old US 70 (SR 1400), placed on one-way streets in downtown Raleigh, and rerouted on a more direct route between Smithfield and Princeton along existing secondary roads, leaving behind US 70A through Selma.

In 1967 US 70 was rerouted onto O. Henry Boulevard to Wendover Avenue in Greensboro; its old alignment along Market Street was downgraded to secondary roads.

South of the Raleigh Beltline, it continued along Saunders, then Wilmington Street, and through Garner to I-40; the reroute in Wake County replaced all of US 70 Bus.

[80][81] Planning for the bypass began in 1991, but construction did not start until 2005 because of several delays regarding the dwarf wedgemussel, an endangered species, habitat in the area.

On October 5, 2019, NCDOT submitted an application to AASHTO, and received approval, for the re-routing of US 70 in Greensboro, High Point, and part of Thomasville.

[117][118] A 5-mile (8.0 km) section of US 70 at Wilson's Mills, connecting to the Clayton Bypass in the west will be upgraded to a freeway for an estimated $31 million.

[130] Part of the project will also build service roads along the freeway as well as approximately 6.5 miles (10.5 km) of new roadway that will be south of the current US 70 alignment in the Kinston area.

[131] When complete, the bypass would improve regional mobility, connectivity, and capacity for US 70, reducing traffic congestion and delays that exist along US 70 between La Grange and Dover.

[134][135] In James City, a 5.1-mile (8.2 km) segment of the US 70 improvement project will upgrade the existing highway to freeway standards by elevating it over existing surface streets as a six-lane, median divided freeway, improving the frontage roads, removing 49 businesses and 17 homes, converting the five intersections along this segment to interchanges with all but one of them being dogbones (the other will be a parclo), and eliminating a railroad crossing just south of exit 417.

[150][151] According to Balfour Beatty, the project includes the construction of 15 bridges, which will require around 4.43 million cubic meters of borrow material and 288,000 tonnes of asphalt.