In North Carolina the highway runs for 80.4 miles (129.4 km) in the southeastern region of the state.

[5] US 76 reaches its eastern terminus on the south side of Wrightsville Beach, at an intersection with Water Street.

As early as 1916, portions of modern-day US 76, between Wilmington and Whiteville were added to the North Carolina state highway system.

As US 76 approaches the Lumber River, it begins a gradual turn to the northeast which is completed before reaching NC 904.

The highway briefly enters the town limits but is routed to the north of the central business area of Chadbourn.

The exit also provides access to the western terminus of NC 214 which begins to parallels the highway until Bolton.

[11] The freeway ends at an at-grade intersection with Chaunceytown Road, northwest of the town of Lake Waccamaw.

Making a gradual turn to the southeast, the highway meets the eastern terminus of NC 214 at an at-grade intersection.

US 74 and US 76 continues east along a rather straight alignment before meeting the southern terminus of NC 11 at an at-grade intersection.

After crossing Livingston Creek, US 74 and US 76 enter the community of Delco from the east, running through the central business area.

US 74 and US 76 continue to the east and near Malmo, the highway begins to parallel a railroad owned and operated by CSX Transportation.

The freeway makes a turn to the southeast, crossing over Village Road and the railroad operated by CSX Transportation.

Entering into Leland, the highway runs through a residential area, crossing over Sturgeon Creek and under Old Fayetteville Road.

The highway then meets NC 133 roughly 0.6 miles (970 m) to the east at a diverging diamond interchange, providing access to the central business area of Leland and Belville.

[10] US 17 and US 76 enters a residential area located between Mimosa Place and Independence Boulevard, and passes north of the Cape Fear Country Club.

At Greenville Loop Road, the highway turns to the north and crosses the sound on the Trooper Clarence L. Swartz Bridge.

US 76 turns south to follow Waynick Boulevard, paralleling Banks Channel on its eastern shore.

At the end of Lumina Avenue, the highway makes a sharp right turn and briefly heads west along Jack Parker Boulevard.

The eastern terminus of US 76 coincides with the end of Jack Parker Boulevard, located at an intersection with Water Street.

The segment between the South Carolina state line and Chadbourn was numbered as part of NC 202.

[18] Upon the creation of the United States Numbered Highway System, US 76 was routed between Chattanooga, Tennessee and Florence, South Carolina.

The highway then continued to follow Village Road, crossing the Brunswick River south of the modern-day bridge.

[20] US 74 and US 76 turned to the north at modern-day US 421, utilizing the Isabel Holmes Bridge to cross the Northeast Cape Fear River.

It then followed Wrightville Avenue to Wrightsville Beach where the road name changed to Causeway Drive.

[34] The freeway around Whiteville was extended east in October 1986, bypassing the towns of Lake Waccamaw and Hallsboro.

[36] The final readjustment of US 76 occurred in 2003, when it was removed from Wrightsville Avenue between Oleander Drive and Eastwood Road.

[38] The extension was proposed to run along a new route between the South Carolina state line and Chadbourn.

[41] A $9.4 million project to replace an at-grade intersection at Hallsboro Road with an interchange began on August 6, 2018.

[48][49] An additional project (U-5704) would either upgrade the intersection or create an interchange at Oleander Drive and College Road.

[50] NCDOT also completed a draft feasibility study to replace the C. Heide Trask Memorial Bridge in Wrightsville Beach.