This Piney River is not to be confused with the Piney River which drains a portion of the Cumberland Plateau in East Tennessee.

The Piney River of Middle Tennessee rises in Dickson County, Tennessee near the city of Dickson. Dickson is located on the "Tennessee Valley Divide", which corresponds for some distance with the downtown's Main Street. The western part of the town, the part in the Tennessee Valley (as opposed to the Cumberland Valley) is drained by tributaries to the Piney. The city lakes, formerly a water supply source and the site of an early electrical power plant even before this, are on a Piney River tributary, as was a former city sewer plant, which was closed when a larger water intake was built further down on the Piney. The upper reaches of the Piney were inadequate for the area's needs, and a pipeline to the Cumberland River in the north end of the county has now been completed, relieving the Piney of the burden of supplying the water needs to a growing community that threatened soon to exhaust it.

The West and East Piney Rivers flow together near the Mt. Sinai community of Dickson County; this confluence marks the true head of the stream. The stream flows from this point south south-east into Hickman County, where it meets the waters of the Duck River a few miles west north-west of Centerville. Its major tributary in Hickman County is Mill Creek, a scenic stream which is frequently stocked with trout by the Tennessee Wildlife Resources Agency.

This Piney River is not to be confused with the Piney River (East Tennessee) which drains a portion of the Cumberland Plateau and forms a large embayment of Watts Bar Lake near its mouth with the Tennessee River.