| Middle Fork Little Horse Creek | rises in NW Ashe County and flows E into Little Horse Creek. |
| Middle Fork Muddy Creek | See Salem Creek. |
| Middle Fork of Ivy Township | former township in E Madison County, now township no. 4. |
| Middle Fork Ridge | NE Swain County in Great Smoky Mountains National Park, a spur extending SW from Dashoga Ridge, lat. 35°39'15" N., long. 83°15'30" W. |
| Middle Fork Township | E central Forsyth County. |
| Middle Fork [Barkers Creek] | rises in W Jackson County and flows NE to join West Fork in forming Barkers Creek. |
| Middle Fork [Grassy Creek] | rises in S Mitchell County and flows NE to join East Fork [Grassy Creek] in forming Grassy Creek. |
| Middle Fork [Hawk Branch] | rises in N Yancey County and flows SW to join South Fork [Hawk Branch] in forming Hawk Branch. |
| Middle Fork [Lower Creek] | rises in NE Caldwell County and flows SW into Zacks Fork. |
| Middle Fork [Raven Fork] | rises in NE Swain County in Great Smoky Mountains National Park and flows SW to join Left Fork and Right Fork in forming Raven Fork [Oconaluftee River]. |