Virginia, and North and SC have declared states of emergency and authorities as far north as New Jersey are warning people along the coast to take precautions, including for the possibility of flooding rains far inland.
The storm is expected to reach SC and North Carolina later this week.
"Please be prepared, be careful and be SAFE!"
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A hurricane watch and storm surge watch have been issued for the entire coast of North Carolina, including Albemarle and Pamlico Sounds, and the SC coast as far south as Edisto Beach.
The evacuation will begin, Tuesday, September 11 at 8:00 a.m.
Kim Buttrick, a National Weather Service meteorologist, said Florence and the two other hurricanes now over the Atlantic - Isaac and Helene - are not expected to have any direct impact on New England.
The storm's first effects were already apparent on barrier islands as unsafe rip currents hit beaches and seawater flowed over a state highway.
Florence will produce very heavy rain along the coast and further inland.
At this height of the Atlantic hurricane season, Florence was being trailed on east-to-west paths by two other hurricanes, Helene and Isaac.
Here are 3 more hurricanes that aren't named Florence
In 2015, heavy flooding in Columbia made the logistics of hosting a game impossible, so the game was moved to LSU . The governors of North and SC and Virginia have all declared states of emergency ahead of the approaching storm.
Hurricane Florence is predicted to slam into the US East Coast as a "major" storm. "We are going to put everything else away and then we are going to put some concrete blocks in front of the doors just so rushing water and wind can't blow the doors back in", said Matthew Littleton with Casper's Marina.
And the timing couldn't be more apt: Monday is the peak of the Atlantic hurricane season, when storm activity is historically at its highest.
The hurricane center said, "All indications are that Florence will be an extremely unsafe Category 4 hurricane while it moves over the western Atlantic toward the southeastern United States".
Hurricane Fran was the last major hurricane to make landfall in the region, coming ashore as a Category 3 storm over Cape Fear, N.C., in 1996.
Henry McMaster, governor of SC, warned the United States should be braced for the hurricane to hit. As of 5 p.m., hurricane-force winds extend outward up to 40 miles from the storm's center, while tropical storm-force winds extend out 150 miles. While Helene's outlook calls for it to head into the open Atlantic, Isaac will probably hit the Caribbean's Lesser Antilles Islands Thursday and potentially brush Puerto Rico, still recovering from last year's Maria, as a strong tropical storm later. McMaster estimated about 1 million residents would be fleeing the coast before Florence's arrival. Tens of thousands of people are also expected to seek higher ground along coastal areas of North Carolina. "This is the craziest one". This happened in September of a year ago, and in September of 2010. Roberts said he's telling them to get out of town. This is a very risky hurricane. "But on rare occasions, the steering patterns can line up such that a storm slips into a dead zone between troughs and ridges".
North Carolina has ordered the evacuation of more than 50,000 people.
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On Monday afternoon, nurse Barbara Mack was using a small shovel to fill sandbags at a public works facility in Charleston - but she saw a silver lining in the hurricane preparations. And out here we're so fragile.