| 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]. |
| Middle Fork [Reddies River] | rises in NW Wilkes County and flows SE to join North Fork [Reddies River] in forming Reddies River. |
| Middle Fork [Rock Creek] | rises in S Yancey County and flows E to join North Fork [Rock Creek] in forming Rock Creek. |
| Middle Fork [South Fork New River] | rises in S Watauga County on E limits of town of Blowing Rock and flows NE and then N to join East Fork and Flannery Fork in forming South Fork New River approx. 2 mi. SE of town of Boone. |
| Middle Fork [Upper Creek] | rises in S Yancey County and flows SE to join South Fork [Upper Creek] in forming Upper Creek. |
| Middle Fourth Creek | See Morrison Creek. |
| Middle Ground | a former shoal between Oak Island and Bald Head (Smith Island) in SE Brunswick County; appears on the Collet map, 1770. It is called Sea Cattle on the Price map, 1808, but the shoal had eroded and was practically gone by 1833 (MacRae map). |
| Middle Little River | rises in E Caldwell County and flows SE into Alexander County, where it enters Lake Hickory on Catawba River. |
| Middle Marshes | a group of tidal-marsh islands at the NW end of Back Sound in SE Carteret County. |