It borders Analanjirofo region in the north, Alaotra-Mangoro in the west, Vakinankaratra and Amoron'i Mania in the southwest, and Vatovavy in the south.

The region contains over 285km of coastline, which includes many beaches and cultural heritage sites.

The area of Atsinanana is 21,934 km2 (8,469 sq mi), almost exactly the same as its neighbor, Analanjirofo.

[3] The current governor of Atsinanana is Richard Théodore Rafidison.

The remaining airports are unpaved pistes, without regular commercial flights: There is only one railroad line that leads to the capitol Antananarivo via Brickaville by Madarail but passenger services are only available up to Moramanga.