Atkinson made his Premier League officiating debut on 18 September 2004 in a match between Crystal Palace and Manchester City.

In September 2010, Atkinson was handed a one-week demotion to the role of fourth official after a time-keeping dispute with Everton manager David Moyes.

[6][better source needed] On 22 May 2022, Atkinson was in charge of his final Premier league match, between Crystal Palace and Manchester United at Selhurst Park, which also happens to be the ground he made his debut 17 years ago.

[citation needed] At the time of his retirement, he had refereed 462 games in the Premier league, which is second highest in the competition, after Mike Dean's 560.

[citation needed] Atkinson refereed the 2006 FA Community Shield match at the Millennium Stadium in Cardiff.

That season he refereed four matches, including FC Zürich against Real Madrid and Inter Milan versus Dynamo Kyiv.

He issued his first Champions League red card on 5 April 2011, to Cristian Chivu of Inter Milan as they lost 5–2 at home to Schalke.

Atkinson officiated multiple matches during 2010 FIFA World Cup Qualification, including the UEFA group 4 qualifying game between Germany and Finland in Hamburg on 14 October 2009 which ended 1–1.

With no English officials being selected for the 2018 World Cup, the first time since 1938,[13] Atkinson refereed his last international match in March 2018, a friendly between Argentina and Italy at the Etihad Stadium in Manchester.