Background: Tuberculosis (TB) remains a major public health concern in India, which bears the highest global burden despite decades of control efforts under the National TB Elimination Programme (NTEP). Misconceptions about TB transmission, particularly regarding non-airborne routes, continue to impede early diagnosis, treatment adherence, and stigma reduction. Understanding community-level knowledge and its socio-demographic determinants is essential for designing targeted interventions, especially in geographically unique settings such as Shimla district, Himachal Pradesh, where urban and rural populations coexist within challenging mountainous terrain. Materials and Methods: A descriptive, cross-sectional study was conducted from Jan to March 2025 among 400 adults (≥18 years) residing in Shimla district. Data were collected using a bilingual (English/Hindi) structured questionnaire hosted on Google Forms, distributed via social media, community networks, and local health workers to ensure representation from both urban and rural areas. The survey captured socio-demographic characteristics and responses to 20 multiple-choice questions assessing knowledge and misconceptions about TB transmission. Each correct answer scored 1 point (range: 0–20), with knowledge classified as very good (16–20), good (12–15), fair (8–11), or poor (0–7). Data were analyzed using descriptive statistics, chi-square tests, and multivariate logistic regression to identify independent predictors of good knowledge (score ≥12). Results: Participants were evenly split between rural and urban areas (50% each) and represented diverse age, education, and income groups. Overall, 71.5% correctly identified the causative organism, 78.0% recognized airborne droplet transmission, and 85.5% knew TB is curable with proper treatment. However, misconceptions persisted—only 67.5% knew TB does not spread via handshakes and 65.5% rejected utensil-based transmission. Knowledge classification showed 29.5% with very good knowledge, 40.5% good, 21.0% fair, and 9.0% poor. Educational attainment and household income were strong, independent predictors of good knowledge: graduates had over four times higher odds (AOR=4.62, p<0.001) and those earning >INR 30,000 nearly four times higher odds (AOR=3.92, p<0.001) compared to the lowest reference groups. Conclusion: While TB-related knowledge in Shimla district is generally high, persistent misconceptions—particularly about non-airborne transmission—pose a barrier to effective TB control. Socio-economic factors, notably education and income, strongly influence knowledge levels. Tailored, precision-focused IEC strategies targeting low-education and low-income groups, alongside existing NTEP efforts, are essential to bridge knowledge gaps, combat stigma, and accelerate progress toward India’s 2025 TB elimination goal in this Himalayan setting.