With its headwaters in North Carolina, the river is 228 miles long in its entirety, including 102 miles within the state of Tennessee. It joins the Holston River in Knox County above Knoxville, where it then becomes the Tennessee River; the river downstream of Douglas Dam is one of the few warm tailwaters found in east Tennessee, where lake sturgeon and smallmouth bass are stocked; along with paddling and fishing there are trails for hiking in Seven Islands State Park; small canoe/kayak launch